We use cookies to distinguish you from other users and to provide you with a better experience on our websites. Close this message to accept cookies or find out how to manage your cookie settings.
To save content items to your account,
please confirm that you agree to abide by our usage policies.
If this is the first time you use this feature, you will be asked to authorise Cambridge Core to connect with your account.
Find out more about saving content to .
To save content items to your Kindle, first ensure [email protected]
is added to your Approved Personal Document E-mail List under your Personal Document Settings
on the Manage Your Content and Devices page of your Amazon account. Then enter the ‘name’ part
of your Kindle email address below.
Find out more about saving to your Kindle.
Note you can select to save to either the @free.kindle.com or @kindle.com variations.
‘@free.kindle.com’ emails are free but can only be saved to your device when it is connected to wi-fi.
‘@kindle.com’ emails can be delivered even when you are not connected to wi-fi, but note that service fees apply.
A public health emergency was declared for the opioid crisis in 2017 and remains in place. Between 2017-2024, there were 164 billion dollar disasters. People who use drugs (PWUDs) are highly susceptible to disasters; however adaptive capacity of opioid treatment programs (OTP) is not well understood. Identifying and addressing gaps to increase resilience and reduce morbidity and mortality among PWUDs is critical.
Methods
A semi-structured interview guide with 8 questions was developed to assess how disasters impact service provision and other aspects of OTPs. OTP leaders, government officials, community health navigators, and advocates received an email invitation to complete an interview via Zoom. Transcripts were independently hand coded to inductively identify themes.
Results
Eleven interviews were completed. Four themes were identified including client challenges securing housing and reliable transportation, disaster-related communication barriers, stigma around help seeking, and issues related to policies and practices such as regulations and insurance coverage that are inflexible during a disaster.
Conclusions
Disruptions to OTPs during disasters require preparedness planning adaptations like more flexible guest dosing. The ongoing public health emergency of the opioid epidemic and the increasing frequency and severity of climate and weather emergencies requires adaptations to a highly regulated system to address vulnerabilities.
Parvovirus B19 (PVB19) myocarditis is a life-threatening condition with high morbidity and mortality in children. While electrocardiograms are commonly used in the early assessment of myocarditis, no specific electrocardiogram pattern has been consistently linked to PVB19. The objective of this study is to identify a distinctive electrocardiogram pattern associated with PVB19 myocarditis and evaluate its diagnostic accuracy.
Methods:
This retrospective case–control study included 77 paediatric patients diagnosed with acute myocarditis at a single centre in Barcelona over 16 years (August 2008–September 2024). Twenty patients had PVB19 myocarditis, confirmed by polymerase chain reaction in blood or endomyocardial biopsy, while 57 patients had myocarditis caused by other viruses. Electrocardiogram were assessed by three cardiologists blinded to the aetiological diagnosis.
Results:
A specific electrocardiogram pattern in the limb leads, characterised by peaked P waves, low QRS complex voltages, and altered repolarisation (manifesting as negative or flat T waves, with or without QTc prolongation), was observed in 14 of 20 patients (70%) with PVB19 myocarditis. Two additional patients exhibited low voltages and altered repolarisation without peaked P waves, and all demonstrated repolarisation abnormalities. In contrast, only 1 of 57 patients with myocarditis from other viruses exhibited the full electrocardiogram pattern. The pattern demonstrated a specificity of 98% and a sensitivity of 70% for PVB19 myocarditis.
Conclusion:
The identified electrocardiogram pattern shows strong diagnostic specificity for PVB19 myocarditis in paediatric patients and may serve as a useful early diagnostic tool. Further multicentre studies are needed to confirm these findings and explore their clinical implications.
Today, two touchstones of the conservative legal movement are support for the unitary executive theory and skepticism of affirmative action policies. This article reveals a connection between these two positions, demonstrating how policy disputes over civil rights contributed to conservative efforts to increase and legitimize presidential control over the bureaucracy through the controversial claim that the president possesses the whole executive power under Article II. Specifically, I examine two intertwined controversies from 1983, which pit the Reagan White House and Department of Justice (DOJ) against the Equal Employment Opportunity Commission (EEOC) and U.S. Commission on Civil Rights (USCCR), two agencies that Reagan officials viewed as obstacles to pursuing its preferred civil rights agenda. Conflicts between the DOJ and EEOC led the administration to deploy the unitary executive theory to help centralize control over its civil rights litigation strategy, while clashes with the USCCR spurred the administration to assert the theory's tenets amid battles over that agency's reauthorization. While these episodes yielded mixed political and legal outcomes, the early articulations of the unitary executive theory that emerged helped to elaborate and advance a controversial constitutional doctrine about presidential power that has become increasingly consequential over time.
Large-eddy simulation (LES) is performed to study the tip vortex flow in a ducted propulsor geometry replicating the experiments of Chesnakas & Jessup (2003, pp. 257–267), Oweis et al. (2006a J. Fluids Engng128, 751–764) and Oweis et al. (2006b J. Fluids Engng128, 751–764). Inception of cavitation in these marine propulsion systems is closely tied to the unsteady interactions between multiple vortices in the tip region. Here LES is used to shed insight into the structure of the tip vortex flow. Simulation results are able to predict experimental propeller loads and show agreement with laser Doppler velocimetry measurements in the blade wake at design advance ratio, $J=0.98$. Results show the pressure differential across the blade produces a leakage vortex which separates off the suction side blade tip upstream of the trailing edge. The separation sheet aft of the primary vortex separation point is shown to take the form of a skewed shear layer which produces a complex arrangement of unsteady vortices corotating and counter-rotating with the primary vortex. Blade tip boundary layer vortices are reoriented to align with the leakage flow and produce instantaneous low-pressure regions wrapping helically around the primary vortex core. Such low-pressure regions are seen both upstream and downstream of the propeller blade trailing edge. The trailing edge wake is found to only rarely have a low-pressure vortex core. Statistics of instantaneous low pressures below the minimum mean pressure are found to be concentrated downstream of the blade’s trailing edge wake crossing over the primary vortex core and continue in excess of 40 % chord length behind the trailing edge. The rollup of the leakage flow duct boundary layer behind the trailing edge is also seen to produce counter-rotating vortices which interact with the primary leakage vortex and contribute to strong stretching events.
Although B vitamins have been shown to play beneficial roles in bone health, the effects of vitamin B1 in humans are still unclear. This study aimed to investigate the effects of vitamin B1 supplementation on middle-aged and older adults. This single-armed trial study included community-dwelling adults in Japan and used a pre- and post-test design. The participants were given 28.0 mg of vitamin B1 supplementation per day for 1 month in addition to their daily usual diet. The effect of this treatment on bone turnover markers and metabolism was evaluated at baseline and after 1 month. Forty-two participants were enrolled (mean age, 58.6 ± 10.4 years; 36 women). The vitamin B1 levels in whole blood increased significantly from baseline after vitamin B1 supplementation. The level of serum tartrate-resistant acid phosphatase 5b (TRACP 5b), a bone resorption marker, reduced significantly (378 ± 135 vs. 335 ± 120 mU/dL, p < 0.001), while the level of N-terminal propeptide of type I procollagen (P1NP), a marker specific to bone formation, did not change. Moreover, the serum phosphorus and parathyroid hormone (PTH) concentrations did not change, whereas the corrected serum calcium concentrations increased and vitamin D concentrations decreased. The serum TRACP 5b levels decreased after vitamin B1 supplementation in the middle-aged and older adults. Further definitive trials are needed to determine the efficacy of vitamin B1 in improving bone health.
An increasing number of older adults require residential care. Concurrently, older adults’ alcohol use is increasing. This review explored the perspectives of all relevant stakeholders on older adults’ alcohol use within residential care settings, through a systematic review and thematic synthesis of qualitative studies. Eight databases were searched for qualitative studies focusing on older adults’ alcohol consumption (defined as aged ≥ 50) within residential care settings, sampling any involved stakeholders, published up until January 2024. Quality appraisal utilised the Critical Appraisal Skills Programme checklist and included 15 studies of mainly moderate quality across seven high-income countries, reporting data from a range of stakeholders and representing varied older adults’ alcohol histories. Three themes were identified: alcohol use by older adults is socially acceptable and purposeful in residential care settings; alcohol helps in the pursuit of an ‘ideal’ outcome; and decision-making around older adults’ alcohol use varies depending on the involvement, knowledge, skills and beliefs of the participating stakeholders, who also vary. Reports of problematic alcohol use were rare and older adults in residential care settings should be supported to exercise their own choice in determining their alcohol use. However, residential care settings face particular challenges in managing the alcohol intake of older adults with limited mental capacity and alcohol dependency; owing to a lack of guidance, front-line staff make subjective decisions. Future research should develop guidance that involves all relevant stakeholders, including family members. Limitations include lack of generalisability to low- and middle-income countries and limited availability of raw data.
Emerging wildlife pathogens often display geographic variability due to landscape heterogeneity. Modeling approaches capable of learning complex, non-linear spatial dynamics of diseases are needed to rigorously assess and mitigate the effects of pathogens on wildlife health and biodiversity. We propose a novel machine learning (ML)-guided approach that leverages prior physical knowledge of ecological systems, using partial differential equations. We present our approach, taking advantage of the universal function approximation property of neural networks for flexible representation of the underlying dynamics of the geographic spread and growth of wildlife diseases. We demonstrate the benefits of our approach by comparing its forecasting power with commonly used methods and highlighting the obtained insights on disease dynamics. Additionally, we show the theoretical guarantees for the approximation error of our model. We illustrate the implementation of our ML-guided approach using data from white-nose syndrome (WNS) outbreaks in bat populations across the US. WNS is an infectious fungal disease responsible for significant declines in bat populations. Our results on WNS are useful for disease surveillance and bat conservation efforts. Our methods can be broadly used to assess the effects of environmental and anthropogenic drivers impacting wildlife health and biodiversity.
This chapter presents the tools for the comparative institutional analysis of amendments. It defines the core of a constitution as the provisions that cannot be altered given the amendment rules and the preferences of the relevant actors. The larger the core, the fewer and less significant the amendments. This simple rule is used to calculate an institutional index of rigidity of each constitution. Given that the preferences of the actors are not known, the index is based only on the amendment provisions and provides a necessary but not sufficient condition for amendments: When the constitution has high rigidity, amendments will be rare and/or insignificant, but when the constitution has low rigidity, there may or may not be frequent and/or significant amendments.
The use of explosive weapons in populated areas (EWIPA) has a disproportionate impact on civilians. Many humanitarian organizations utilize varying sheltering guidelines to recommend safe positions for civilians affected by explosive threats. It is not known whether these recommendations are standardized or derived from evidence. This study aimed to identify existing recommendations and potential gaps in literature relevant to sheltering guidelines for civilians during explosive events.
Methods
A scoping review was conducted of the literature including indexed databases and grey literature to identify reports that described sheltering guidelines for civilians during explosive events. Preferred Reporting Items for Systematic Reviews and Meta-Analyses extension for Scoping Reviews (PRISMA-ScR) methodology was followed.
Results
The search identified 3582 peer-reviewed records. After title/abstract and full text screening, only 2 peer-reviewed reports remained eligible. These were combined with 13 gray literature reports obtained from humanitarian organizations and internet searches. The peer-reviewed reports included mine and unexploded ordnance guidelines, not guidelines for EWIPA or aerial bombardments. There is a substantial knowledge gap and heterogeneity in existing sheltering guidelines from explosive events, particularly those appropriate for protection from EWIPA.
Conclusions
Findings from this scoping review demonstrate a need for the creation and standardization of evidence-based civilian sheltering guidelines to mitigate the threat of explosive weapons to civilians in conflict.
Studies conducted during the COVID-19 pandemic found high occurrence of suicidal thoughts and behaviours (STBs) among healthcare workers (HCWs). The current study aimed to (1) develop a machine learning-based prediction model for future STBs using data from a large prospective cohort of Spanish HCWs and (2) identify the most important variables in terms of contribution to the model’s predictive accuracy.
Methods
This is a prospective, multicentre cohort study of Spanish HCWs active during the COVID-19 pandemic. A total of 8,996 HCWs participated in the web-based baseline survey (May–July 2020) and 4,809 in the 4-month follow-up survey. A total of 219 predictor variables were derived from the baseline survey. The outcome variable was any STB at the 4-month follow-up. Variable selection was done using an L1 regularized linear Support Vector Classifier (SVC). A random forest model with 5-fold cross-validation was developed, in which the Synthetic Minority Oversampling Technique (SMOTE) and undersampling of the majority class balancing techniques were tested. The model was evaluated by the area under the Receiver Operating Characteristic (AUROC) curve and the area under the precision–recall curve. Shapley’s additive explanatory values (SHAP values) were used to evaluate the overall contribution of each variable to the prediction of future STBs. Results were obtained separately by gender.
Results
The prevalence of STBs in HCWs at the 4-month follow-up was 7.9% (women = 7.8%, men = 8.2%). Thirty-four variables were selected by the L1 regularized linear SVC. The best results were obtained without data balancing techniques: AUROC = 0.87 (0.86 for women and 0.87 for men) and area under the precision–recall curve = 0.50 (0.55 for women and 0.45 for men). Based on SHAP values, the most important baseline predictors for any STB at the 4-month follow-up were the presence of passive suicidal ideation, the number of days in the past 30 days with passive or active suicidal ideation, the number of days in the past 30 days with binge eating episodes, the number of panic attacks (women only) and the frequency of intrusive thoughts (men only).
Conclusions
Machine learning-based prediction models for STBs in HCWs during the COVID-19 pandemic trained on web-based survey data present high discrimination and classification capacity. Future clinical implementations of this model could enable the early detection of HCWs at the highest risk for developing adverse mental health outcomes.
This cross-sectional study aimed to investigate the correlation between magnesium consumption and periodontitis in different body mass index (BMI) and waist circumference (WC) groups. 8385 adults who participated in the National Health and Nutrition Examination Survey during 2009–2014 were included. The correlation between dietary magnesium intake and periodontitis was first tested for statistical significance by descriptive statistics and weighted binary logistic regression. Subgroup analysis and interaction tests were performed to investigate whether the association was stable in different BMI and WC groups. There was a statistical difference in magnesium intake between periodontitis and non-periodontitis populations. In model 3, participants with the highest magnesium consumption had an odds ratio of 0.72 (0.57-0.92) for periodontitis compared to those with the lowest magnesium consumption. However, in subgroup analysis, the relationship between magnesium intake and periodontitis remained significant only in the non-general obese (BMI ≤ 30 kg/m2) and non-abdominal obese populations (WC ≤ 102 cm in men and ≤ 88 cm in women). Dietary magnesium intake might decrease the periodontitis prevalence in the American population, and this beneficial periodontal health role of magnesium consumption might only be evident in non-general obese and non-abdominal obese populations.
Judge Roberto Carlos Vidal López is a Lawyer and Professor at the Pontificia Universidad Javeriana in Bogotá, where he gained a PhD in law. Since 1997 he has been a Professor and Expert Researcher there on human rights, international humanitarian law (IHL), forced migration and internal displacement. He has also studied history.
In addition to his work as a Professor, Judge Vidal López has been a Lecturer at the Universidad del Rosario and a Visiting Researcher at the University of Essex in the United Kingdom. He has worked for the Ideas for Peace Foundation, the United Nations in Colombia, the International Association for the Study of Forced Migration, the University Network for Peace, the Ombudsman’s Office of Colombia and the Brookings Institution, a major Washington-based think tank. He has also produced thirty publications, including Truth-Telling and Internal Displacement in Colombia (2012), The Participation of Internally Displaced People in Peace Processes in Colombia (2007) and Derecho global y desplazamiento interno: Creación, uso y desaparición del desplazamiento forzado por la violencia en el derecho contemporáneo (2007).
Security alliances are often portrayed as vital tools for advancing US national objectives. Yet alliance networks, critics charge, also carry some undesirable side effects and risks. The so-called problem of moral hazard is one of them. In this context, US Baltic allies have long been spotlighted as prime suspects that may one day rope their superpower patron into an unwanted conflict. With Washington having their backs at all times, the argument goes, the Baltic republics are free to pursue ill-advised policies and press their claims against Russia. While the charge of alliance entrapment via Tallinn, Vilnius, and Riga has been routinely evoked, it has not been rigorously examined. This study addresses this gap in the literature. The material presented speaks to the fact that the narrative of the Baltic countries as recklessly minded US allies does not hold up to empirical scrutiny. Structural factors, namely power disparity with the potential adversary, push against the logic of the Baltics undertaking provocative moves. That said, the paper concedes a half-point, namely that the US role in securing the Baltic region is not entirely risk-free and that Washington has assumed greater burdens than it anticipated during the initial alliance formation stage.
This article reviews the evolution of the representation of Italy’s ‘Catholic partisan’. In essence, this involved adaptation of the model of the Catholic soldier, who was able to kill out of love and ‘without hatred’, to the context of a civil war. With particular reference to the case of the central Veneto, this examination looks back to earlier Italian experiences during wartime to help explain how Catholic activists and the partisan groups linked to the Catholic world addressed the key issues of the legitimation of Resistance violence and the control of its use. It emphasises the disparity between the rhetoric directed at containing the violence and the realities of guerrilla warfare. The article goes on to analyse the different models of the ‘Catholic partisan’ put forward in the immediate postwar period (1945–1950): the ‘Catholic soldier’, with his military bearing; the ‘pure martyr’, who never initiated violence; and the ‘devout partisan’, who managed to restrict his use of violence, assessing its costs and benefits, and was characterised by his inclination to forgive and, especially, to kill as little as possible. The conclusions consider how a particular rhetoric helped to shape the narrative of the active involvement of Catholics in the Italian Resistance.
Research quality assessment is a cornerstone of academic practice, yet the criteria that inform such judgments are often assumed rather than critically examined through empirical research. This article draws on a global survey of international relations (IR) scholars (N = 820) to analyze the cognitive dimensions underlying research quality evaluation and their variation across sociological and epistemological factors. We identify seven distinct quality factors: theoretical significance, logical style and structure, practical significance, methodological rigor, contribution and value for future research, interest and topicality, and challenge to existing knowledge. Our results suggest that, while personal preferences, disciplinary norms, and professional practices—shaped by variables such as gender, nationality, and political orientation—influence evaluations, research quality judgments are ultimately grounded in shared cognitive frameworks. Our study offers robust evidence that quality assessments, though subject to sociological variation, reflect deeper, common cognitive structures across scholarly communities.
An often-used normative argument for increasing judicial diversity is that it will enhance public confidence in courts. This paper tests competing perspectives about whether the descriptive representation of women in the federal judiciary will improve institutional trust, using a nationally representative survey experiment. The findings suggest that, in the post-Dobbs era, descriptive representation for gender on low visibility courts yields a positive effect on institutional trust, but that the magnitude of the effect is quite small, time limited, and restricted to Democrats and to those who already have higher levels of trust.