Public or stakeholder participation in environmental governance has been strongly advocated within the United Nations (UN) since the early 1990s. A relatively new mechanism for global climate finance that emphasises stakeholder engagement is the Green Climate Fund (GCF), a UN strategy for channelling funds from the Global North to the Global South. Drawing on previous critical approaches to multi-stakeholder involvement in global governance, this article explores stakeholder involvement within the GCF. The study combines ideas from institutional logics and resource dependency to provide a better understanding of how stakeholder arrangements are shaped in climate organisations. Results show that the GCF stakeholder arrangement favours private sector stakeholders – stakeholders that take a technical and apolitical approach to climate finance – and disfavours smaller, less resourceful stakeholders as well as those who perform a politicised watchdog function.
Background: Psychiatric patients may refer to concepts neither medically accepted nor easily understood to describe their experiences when seeking medical care. These concepts may lie outside the clinician’s cultural references and consequently hinder the diagnostic consultation. In the fifth version of the Diagnostic and Statistical Manual of Mental Disorders (DSM-5), the clinical instrument Cultural Formulation Interview (CFI) was included. The CFI aims to facilitate the gathering and synthesis of culturally relevant clinical information. The notion of Cultural Concepts of Distress (CCD) was also introduced in DSM-5. The CCD include the subterms of the cultural syndrome, cultural explanation, and cultural idiom of distress. No previous study has used CFI for conceptualizing a cultural notion as a CCD. This study aimed to approach the cultural notion of being a highly sensitive person (HSP) in patients with bipolar disorder (BD) by applying the CFI. The cultural notion of HSP has garnered great interest globally, although scientific evidence is limited. No direct correlation between BD and HSP was hypothesized before or during the study process. Methods: In this case study, three patients with BD who reported being HSP were interviewed using the CFI. Furthermore, the applicability of the CCD was examined based on the outcomes of the CFI using an interpretive approach. Results: All three patients reported that the CFI facilitated the clinical consultation, and in one of the cases, it may also have increased the treatment engagement. Based on the synthesis of the CFI outcomes in these illustrative cases, HSP could be understood as a cultural syndrome, a cultural explanation, and a cultural idiom of distress. Conclusion: By applying a person-centered perspective, CFI was used for the conceptualization of a cultural notion as a CCD (i.e., HSP in our study). Moreover, the cases highlight the complexity of illness insight in BD as a medical phenomenon when patients’ illness perspectives are taken into consideration. Future studies need to further examine the clinical relevance of the CFI in the management of BD.
Background Our aim was to assess associations between cardiorespiratory fitness (CRF) and body mass index (BMI) in youth and 5‐year mortality after site‐specific cancer diagnoses in men. Methods Men with cancer from a population who underwent military conscription at ages 16–25 during 1968–2005 in Sweden were included. CRF was assessed as maximal aerobic workload on a cycle ergometer test and was classified as low, moderate, or high. BMI (kg/m ² ) was classified as underweight (<18.5), normal weight (18.5–24.9), overweight (25–29.9), or obesity (>30). Conscription data were linked with register data on cancer diagnosis and mortality. Analyses included CRF, BMI, date of diagnosis, and age, year, and center for conscription. Results A total of 84,621 cancer cases were included. Mean age at diagnosis was 52 years. Follow‐up data were available during a mean of 6.5 years. There were linear protective associations between CRF and mortality after any cancer diagnosis (hazard ratio [HR] for high vs. low CRF 0.70), malignant skin cancer (HR 0.80), non‐Hodgkin lymphoma (HR 0.78), and cancer in the lungs (HR 0.80), head and neck (HR 0.68), pancreas (HR 0.83), stomach (HR 0.78), liver (HR 0.84), rectum (HR 0.79), and bladder (HR 0.71). Overweight and/or obesity were associated with increased mortality after any cancer (HR for obesity vs. normal weight 1.89), malignant skin cancer (HR 2.03), Hodgkin lymphoma (HR 2.86) and cancer in the head and neck (HR 1.38), thyroid (HR 3.04), rectum (HR 1.53), kidney (HR 1.90), bladder (HR 2.10), and prostate (HR 2.44). Conclusion We report dose‐dependent associations between CRF and BMI in youth and mortality after site‐specific cancer diagnoses in men. The associations with mortality could be due to both cancer inhibition and an improved tolerance to withstand cancer treatment. These results strengthen the incentive for public health efforts aimed at establishing a high CRF and normal weight in youth.
In 1991 Hébrard introduced a factorization of words that turned out to be a powerful tool for the investigation of a word’s scattered factors (also known as (scattered) subwords or subsequences). Based on this, first Karandikar and Schnoebelen introduced the notion of k-richness and later on Barker et al. the notion of k-universality. In 2022 Fleischmann et al. presented at DCFS a generalization of the arch factorization by intersecting the arch factorization of a word and its reverse. While the authors merely used this factorization for the investigation of shortest absent scattered factors, in this work we investigate this new \(\alpha \)-\(\beta \)-factorization as such. We characterize the famous Simon congruence of k-universal words in terms of 1-universal words. Moreover, we apply these results to binary words. In this special case, we obtain a full characterization of the classes and calculate the index of the congruence. Lastly, we start investigating the ternary case, present a full list of possibilities for \(\alpha \beta \alpha \)-factors, and characterize their congruence.
Introduction Chronic graft-versus-host disease (cGVHD) is a debilitating side effect of allogeneic hematopoietic cell transplantation (HCT), affecting the quality of life of patients. We used whole exome sequencing to identify candidate SNPs and complete a multi-marker gene-level analysis using a cohort of cGVHD( +) (N = 16) and cGVHD( −) (N = 66) HCT patients. Methods Saliva samples were collected from HCT patients (N = 82) pre-conditioning in a multi-center study from March 2011 to May 2018. Exome sequencing was performed and FASTQ files were processed for sequence alignments. Significant SNPs were identified by logistic regression using PLINK2v3.7 and Fisher’s exact test. One cGVHD( −) patient sample was excluded from further analysis since no SNP was present in at least 10% of the sample population. The FUMA platform’s SNP2GENE was utilized to annotate SNPs and generate a MAGMA output. Chromatin state visualization of lead SNPs was completed using Epilogos tool. FUMA’s GENE2FUNC was used to obtain gene function and tissue expression from lead genomic loci. Results Logistic regression classified 986 SNPs associated with cGVHD( +). SNP2GENE returned three genomic risk loci, four lead SNPs, 48 candidate SNPs, seven candidate GWAS tagged SNPs, and four mapped genes. Fisher’s exact test identified significant homozygous genotypes of four lead SNPs (p < 0.05). GENE2FUNC analysis of multi-marker SNP sets identified one positional gene set including lead SNPs for KANK1 and KDM4C and two curated gene sets including lead SNPs for PTPRD, KDM4C, and/or KANK1. Conclusions Our data suggest that SNPs in three genes located on chromosome 9 confer genetic susceptibility to cGVHD in HCT patients. These genes modulate STAT3 expression and phosphorylation in cancer pathogenesis. The findings may have implications in the modulation of pathways currently targeted by JAK inhibitors in cGVHD clinical trials.
Background Participation in cardiac rehabilitation in patients with coronary artery disease (CAD) remains underutilised. Digital educational programmes, as part of cardiac rehabilitation, are emerging as a means of increasing accessibility, but healthcare professionals’ perceptions of implementing and using these programmes are not known. The aim of the study was therefore to explore healthcare professionals ̓ perceptions and experiences of implementing and using a digital patient educational programme (DPE) as part of cardiac rehabilitation after acute CAD. Methods Individual semi-structured interviews were performed with 12 nurses and physiotherapists, ten women with a median age of 49.5 (min 37- max 59) years, with experience of using the DPE as part of a phase II cardiac rehabilitation programme in Region Västra Götaland, Sweden. The interviews were transcribed verbatim and analysed with inductive content analysis according to Graneheim and Lundman. Results An overall theme was identified throughout the unit of analysis: “Digital patient education – a complement yet not a replacement”. Within this theme, three main categories were identified: “Finding ways that make implementation work”, “Accessibility to information for confident and involved patients” and “Reaching one another in a digital world”. Each main category contains a number of sub-categories. Conclusions This study adds new knowledge on healthcare professionals’ perceptions of a digital patient educational programme as a valuable and accessible alternative to centre-based education programmes as part of cardiac rehabilitation for patients with CAD. The participants highlighted the factors necessary for a successful implementation, such as support through the process and sufficient time from the employer to learn the system and to create new routines in daily practice. Future research is needed to further understand the impact of digital education systems in the secondary prevention of CAD. Ultimately, hybrid models, where the choice of delivery depends on the preferences of the individual patient, would be the optimal model of care for the future.
In this note, we study the delooping of spaces and maps in homotopy type theory. We show that in some cases, spaces have a unique delooping, and give a simple description of the delooping in these cases. We explain why some maps, such as group homomorphisms, have a unique delooping. We discuss some applications to Eilenberg–MacLane spaces and cohomology.
This study has selected Codex Sinaiticus and Mark 1:1 as a test case to propose a new way for Greek New Testament editions and translations to present textual uncertainties in manuscripts. The article suggests that editors and translators use a partial cancellation type of erasure in a continuous line over problematic text . This method draws inspiration from a technique used by Martin Heidegger and Jacques Derrida known as sous rature (under erasure). This form of limited cancellation aims to expel indifference and elicit a visceral reaction in the reader. The technique also has a philosophical and theological aim, namely, to work within Heidegger’s view of truth as a process of hiding and revealing. Finally, the limited cancellation, which both conceals and shows, fits with the theme of “messianic secret” in Mark’s Gospel, wherein Jesus both reveals and hides his identity.
Background We investigated all-cause and epilepsy-related mortality in patients operated with resective epilepsy surgery and in non-operated patients with drug-resistant epilepsy. Our hypothesis was that patients who proceed to surgery have lower mortality over time compared with non-operated patients. Method Data from 1329 adults and children from the Swedish National Epilepsy Surgery Register and 666 patients with drug-resistant epilepsy who had undergone presurgical work-up but not been operated were analysed. The operated patients had follow-ups between 2 and 20 years. We used the Swedish Cause of Death Register to identify deaths. Autopsy reports were collected for patients with suspected sudden unexpected death in epilepsy (SUDEP). Kaplan-Meier and Cox regression analyses were performed to identify predictors for mortality and SUDEP. Results SUDEP accounted for 30% of all deaths. Surgery was associated with lower all-cause mortality (HR 0.7, 95% CI 0.5 to 0.9), also when adjusted for age, sex and tonic–clonic seizures at inclusion. The benefit of surgery seemed to persist and possibly even increase after 15 years of follow-up. Risk factors of mortality for operated patients were persisting seizures and living alone. Of the operated patients, 37% had seizures, and these had a higher risk of mortality (HR 2.1, 95% CI 1.4 to 3.0) and SUDEP (HR 3.5, 95% CI 1.7 to 7.3) compared with patients with seizure freedom at last follow-up. Conclusions In this large population-based epilepsy surgery cohort, operated patients had a lower all-cause mortality compared with non-operated patients with drug-resistant epilepsy. Seizure freedom was the most important beneficial factor for both all-cause mortality and SUDEP among operated patients.
Depletion of gut microbiota is associated with inefficient energy extraction and reduced production of short‐chain fatty acids from dietary fibers, which regulates colonic proglucagon ( Gcg ) expression and small intestinal transit in mice. However, the mechanism by which the gut microbiota influences dietary protein metabolism and its corresponding effect on the host physiology is poorly understood. Enteropeptidase inhibitors block host protein digestion and reduce body weight gain in diet‐induced obese rats and mice, and therefore they constitute a new class of drugs for targeting metabolic diseases. Enteroendocrine cells (EECs) are dispersed throughout the gut and possess the ability to sense dietary proteins and protein‐derived metabolites. Despite this, it remains unclear if enteropeptidase inhibition affects EECs function. In this study, we fed conventional and antibiotic treated mice a western style diet (WSD) supplemented with an enteropeptidase inhibitor (WSD‐ETPi), analyzed the expression of gut hormones along the length of the intestine, and measured small intestinal transit under different conditions. The ETPi‐supplemented diet promoted higher Gcg expression in the colon and increased circulating Glucagon like peptide‐1 (GLP‐1) levels, but only in the microbiota‐depleted mice. The increase in GLP‐1 levels resulted in slower small intestinal transit, which was subsequently reversed by administration of GLP‐1 receptor antagonist. Interestingly, small intestinal transit was normalized when an amino acid‐derived microbial metabolite, p‐cresol, was supplemented along with WSD‐ETPi diet, primarily attributed to the reduction of colonic Gcg expression. Collectively, our data suggest that microbial dietary protein metabolism plays an important role in host physiology by regulating GLP‐1‐mediated intestinal transit.
Sri Lankan garment workers have navigated a terrain where their initial status as stigmatized labour were re-casted as empowered workers through various industry-led initiatives in the recent past. Rearticulation from disposable to empowered workers, however, did not rest upon living wages or a hike in wage packets; instead, various management interpellations were attempted onsite and offsite factories. Without a material basis for these initiatives in the pre-CoVID-19 period, the vacuity of these tropes became particularly evident during the pandemic. Workers had to come to terms with shabby social support and stigma that worsened their economic lives, with tattered social safety systems compelling labour rights organizations and kin to step up. Using worker testimonies, I speak to the politics of empowerment to underline how the recasting of workers as stigmatized resulted in the cost of social reproduction to borne by kin networks and labour activists too. These frayed social safety nets and public support continue to echo against the country’s worst economic crisis.
The liver is one of the most important organs, with a complex physiology. Current in-vitro approaches are not accurate for disease modeling and drug toxicity research. One of those features is liver zonation, where cells display different physiological states due to different levels of oxygen and nutrient supplements. Organ-on-a-chip technology employs microfluidic platforms that enable a controlled environment for in-vitro cell culture. In this study, we propose a microfluidic design embedding a gas channel (of ambient air), creating an oxygen gradient. We numerically simulate different flow rates and cell densities with the COMSOL Multiphysics package considering cell-specific consumption rates of oxygen and glucose. We establish the cell density and flow rate for optimum oxygen and glucose distribution in the cell culture chamber. Furthermore, we show that a physiologically relevant concentration of oxygen and glucose in the chip is reached after 24 h and 30 min, respectively. The proposed microfluidic design and optimal parameters we identify in this paper provide a tool for in-vitro liver zonation studies. However, the microfluidic design is not exclusively for liver cell experiments but is foreseen to be applicable in cell studies where different gas concentration gradients are critical, e.g., studying hypoxia or toxic gas impact.
In this article, we focus on relational labour as a form of emotional labour associated with the use of platformised possessions, such as pins, messages, photos, videos and playlists hosted on digital platforms, to maintain relationships with friends and family. We argue that this ongoing effort is a type of consumer labour because it generates profitable engagements for digital platforms, which intentionally exploit negative emotions, namely, anxiety and guilt, associated with maintaining social connections. Drawing on 47 depth interviews with people living in the South of the UK, we identify the direct (communication via platforms) and indirect (information gathered via platforms to attain relational goals) relational work undertaken by consumers via their platformised possessions. We then consider the emotional experiences related to this work, demonstrating how such experiences differ from reports of possession work on material goods, while maintaining platform profits. Recognising that this work is the basis of much platform engagement, and hence profit, we further show how this effort becomes a form of unpaid labour. We thus contribute to the nascent literature on platformisation and emotion, to broader studies of possession work, and to critical marketing scholarship on consumer labour.
Introduction 22q11.2 deletion syndrome (22qDS) has been associated with varying levels of social impairments, and with atypical visual scanning of faces. The present study explored whether self-reported sensitivity to eye contact might be related to these phenomena. Method Individuals with confirmed 22qDS were interviewed about their experience and possible discomfort with eye contact. In cases where individuals expresesed discomfort, they were subsequently asked about coping mechanisms used to deal with this discomfort. In addition to self-reported eye contact discomfort, gaze to emotional faces was examined using eye tracking. Results In the subgroup of individuals who reported discomfort during eye contact, eye tracking results revealed a lower amount of gaze in the eyes of neutral faces, as well as the absence of the typical left visual field (LVF) bias, indicative of alterations in hemispheric lateralization. This subgroup also scored lower on a measure of everyday functioning. Conclusions Our results show that, by simply asking individuals with this social and communicative disorder about eye gaze discomfort, we may better understand the specific challenges that they experience. Moreover, information gained from such first-person reports together with eye-tracking measures further informs about the integrity of their face processing system, as well as about the nature and degree of impairment in this population.
This book explores how local peace is built and performed in Lebanon through empirical material from the municipalities of Tyre, Bourj Hammoud and Saida. The book highlights three key points brought forward in the local peacebuilding literature: that peace needs to respond to local needs, that the people living the peace built must be included in building it, and, that peacebuilding in the local space is connected to actors and activities on the national and international level. From these key points, the book explains how local service delivery, local interactions and vertical relationships matter for building peace. Through the stories of municipal councillors, municipal employees, and civil society actors active in the three local spaces, the book demonstrates that local governments hold peacebuilding potential by implementing, for example, waste management, infrastructural developments and social services. At the same time, how local activities and agencies are performed relates to the local context and its relationship to other actors and levels of government. Thus, illustrating how local governments navigate local, national and international spaces to implement local peacebuilding activities, the book argues that politics and societal divides impact how local peacebuilding is performed and what kind of peace(s) is built. Taken together, the book finds that in Lebanon, local peacebuilding is performed through politicized local governance, upholding peace, and conflict, sometimes at the same time.
The HOLLYWOOD sign is arguably the world's most famous language object. Emblematic of prestige and cultural capital, the sign can be found not just in Los Angeles, but in citations all over the world. Beginning with the history of its valorization, HOLLYWOOD is shown to emanate symbolic value through a set of enregistered semiotic features. Drawing upon a set of globally sourced citations of HOLLYWOOD, the circulation and stratified bundling of size, emplacement, alignment, typeface, and color indicates how the citation of language objects is mediated by political economy. A process of diffuse citation is further observed, in which the quotation of language features is not overt, but the source of emanation is still tangible, revealing HOLLYWOOD as the source of a global linguistic-semiotic register. As this register circulates in citations overt and diffuse, language objects are revealed as key sites for the reproduction of commodity values.
Antimicrobial resistance (AMR) is a critical global health threat, and drivers of the emergence of novel strains of antibiotic-resistant bacteria in humans are poorly understood at the global scale. We examined correlates of AMR emergence in humans using global data on the origins of novel strains of AMR bacteria from 2006 to 2017, human and livestock antibiotic use, country economic activity and reporting bias indicators. We found that AMR emergence is positively correlated with antibiotic consumption in humans. However, the relationship between AMR emergence and antibiotic consumption in livestock is modified by gross domestic product (GDP), with only higher GDP countries showing a slight positive association, a finding that differs from previous studies on the drivers of AMR prevalence. We also found that human travel may play a role in AMR emergence, likely driving the spread of novel AMR strains into countries where they are subsequently detected for the first time. Finally, we used our model to generate a country-level map of the global distribution of predicted AMR emergence risk, and compared these findings against reported AMR emergence to identify gaps in surveillance that can be used to direct prevention and intervention policies.
Background Stress-related disorders have become a major challenge for society and are associated with rising levels of sick leave. The provision of support to facilitate the return to work (RTW) for this patient group is of great importance. The aim of the present study was to evaluate whether a new systematic procedure with collaboration between general practitioners (GPs), rehabilitation coordinators (RCs) and employers could reduce sick leave days for this patient group. Method Employed patients with stress-related diagnoses seeking care at primary health care centres (PHCCs) were included in either the intervention group (n = 54), following the systematic intervention procedure, or the control group (n = 58), receiving treatment as usual (TAU). The intervention included a) a training day for participant GPs and RCs, b) a standardised procedure for GPs and RCs to follow after training, c) the opportunity to receive clinical advice from specialist physicians in the research group. Outcome measures for RTW were sick leave days. Results The median number of registered gross sick leave days was lower for the control group at six, 12 and 24 months after inclusion, but the difference was not statistically significant. The control group had significantly fewer net sick leave days at three months (p = 0.03) at six months (p = 0.00) and at 12-months follow-up (p = 0.01). At 24 months, this difference was no longer significant. Conclusions The PRIMA intervention, which applied a standardized procedure for employer involvement in the rehabilitation process for patients with stress-related disorders, actually increased time to RTW compared to TAU. However, at 24 months, the benefit of TAU could no longer be confirmed. The study was registered on 16/01/2017 (ClinicalTrials.gov, NCT03022760).
Metabolic syndrome represents a cluster of conditions such as obesity, hyperglycaemia, dyslipidaemia, and hypertension that can lead to type 2 diabetes mellitus and/or cardiovascular disease. Here, we investigated the influence of obesity and hyperglycaemia on osseointegration using a novel, leptin receptor-deficient animal model, the Lund MetS rat. Machined titanium implants were installed in the tibias of animals with normal leptin receptor (LepR+/+) and those harbouring congenic leptin receptor deficiency (LepR−/−) and were left to heal for 28 days. Extensive evaluation of osseointegration was performed using removal torque measurements, X-ray micro-computed tomography, quantitative backscattered electron imaging, Raman spectroscopy, gene expression analysis, qualitative histology, and histomorphometry. Here, we found comparable osseointegration potential at 28 days following implant placement in LepR−/− and LepR+/+ rats. However, the low bone volume within the implant threads, higher bone-to-implant contact, and comparable biomechanical stability of the implants point towards changed bone formation and/or remodelling in LepR−/− rats. These findings are corroborated by differences in the carbonate-to-phosphate ratio of native bone measured using Raman spectroscopy. Observations of hypermineralised cartilage islands and increased mineralisation heterogeneity in native bone confirm the delayed skeletal development of LepR−/− rats. Gene expression analyses reveal comparable patterns between LepR−/− and LepR+/+ animals, suggesting that peri-implant bone has reached equilibrium in healing and/or remodelling between the animal groups.
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