53417 research outputs found
Sort by
A national survey of dementia diagnosis and care in English memory services.
No full textBACKGROUND: In England, National Health Service (NHS) memory services provide most dementia diagnostic and immediate post-diagnostic care. We aimed to co-design and conduct a survey regarding diagnostic and post-diagnostic care, and perceived readiness for new treatments. METHODS: We invited all memory services in England to complete the survey. We compared services by provider type, investigating whether service characteristics (provider type, rurality, region, referral rates, staffing mix, accreditation) were associated with diagnosis rates and psychological therapy provision. RESULTS: 139/188 (73.9%) memory services participated, 130 (93.5%) provided by mental health/community and 9 (6.5%) by acute trusts. We estimated that English memory services receive 192,418 referrals/year, 98.7% to mental health/community trust services. In these services, the median annual referral rate per Full Time Equivalent (FTE) staff was 100.8 (Interquartile range: 56.7-132.8). Of FTE memory service staff, 14.0% (9.0-19.0%) were doctors. Acute trust-based services reported fewer referrals (45.8, 21.1-99.5) and had more doctors (33.0%, 23.0-43.0% FTE). More acute trust services felt ready to prescribe dementia Disease Modifying Treatments (N = 8 [88.9%]) than mental health/community services (N = 50, [41.7%]), while fewer acute trusts offered post-diagnostic psychological therapy routinely (N = 5 [55.6%]) vs. (N = 100 [77.5%]) in community services. NHS region (β = 0.70 [95% Confidence interval (CI): 0.08, 1.32]) and rurality (β = 2.14, [95% CI: 1.32, 2.96]) predicted lower diagnostic rates; regions with highest dementia diagnosis rates (67%+) had more memory service staff relative to the local aged 65 + population size. CONCLUSION: We identified marked geographical inequalities. People in regions with less resourced memory services and rural areas had less access to timely diagnosis and care
Oral Health-Related Quality of Life (OHRQoL), Pain and Side Effects in Adults Undergoing Different Orthodontic Treatment Modalities: A Systematic Review and Meta-Analysis
Full text linkBackground: The present study aimed to identify the differences between experiences, in terms of oral health-related quality of life, pain, side effects and/or other complications, of adults undergoing orthodontic treatment using removable aligners and fixed labial or lingual appliances. Methods: The review was registered with PROSPERO, and a comprehensive electronic search was undertaken without language or date restrictions. Randomised and non-randomised trials and prospective cohort and cross-sectional studies along with case series were included. The Cochrane Collaboration’s Risk of Bias 2 Tool, Newcastle–Ottawa Scale and The Risk Of Bias In Non-Randomized Studies—of Interventions tools were used to assess quality. Data were grouped in terms of oral health-related quality of life, pain side effects and/or other complications. Results: Data from 35 studies were included; 9 were eligible for meta-analysis. Thus 2611 participants were included related to removable aligners (n = 513), fixed labial (n = 1816) and lingual (n = 218) appliances or a combination (n = 64) of appliances. The standardised mean differences in visual analogue scale pain reports between 24 h and 7 days were −10.02 (95% CI: −11.13, −8.91) for aligners and −6.40 (95%CI: −10.42, −2.38) for labial appliances (p = 0.09). There was a significant improvement in dental self-confidence following fixed labial appliance treatment (p = 0.001). Conclusions: No difference was detected in short-term pain with aligners and labial appliances. Aligners may have less impact on oral health-related quality of life measures compared to labial appliances. Lingual appliances have a persistent impact on speech, despite some adaptability. Any deterioration in oral health-related quality of life measures during treatment appears temporary. Further randomised trials using validated assessment tools and comparing aligners and labial and lingual appliances are required.</jats:p
Towards a sociotechnical ecology of artificial intelligence: power, accountability, and governance in a global context
No full textContemporary artificial intelligence (AI) technologies, particularly those based on foundation models and released at scale, are globally entangled and made up of a complex array of interrelated actors, practices, and transnational flows of resources. The rapid pace at which AI systems are being developed and distributed, is driving significant societal and planetary transformations. While much of the international agenda around governing AI has converged around downstream matters of safe deployment and use, deeper systemic issues—including power concentration, uneven environmental costs, or the asymmetric extraction of data and labour by technology companies—remain contested and unresolved areas of debate. In this paper we centre these systemic challenges, and locate governance entry points aimed at fostering more just futures. We conceptualise contemporary large-scale AI as a sociotechnical ecology comprised of interrelated actors, practices, and asymmetrical resource flows. Using the lens of infrastructural inversion within social studies of infrastructure, we trace the actors involved in the making of AI technologies, their interdependences, and long-term infrastructural continuities that shape them. We argue that new AI models and systems are not unprecedented but are instead built upon and shaped by pre-existing infrastructures, entrenched market relations, and socio-historical patterns. By making visible the sites of accountabilities and technical and non-technical intervention in the AI ecology, we identify four governance imperatives for sustainable and equitable AI governance: (1) Decentralising AI infrastructure, (2) Advancing environmental and epistemic justice through pluriversal AI governance, (3) Instituting cross-border data and data work governance, and (4) Enhancing international coordination, participation and solidarity
Time and the Question of Formalism: International Law’s Pasts and Futures
No full textIn the past quarter century, formalism has taken on renewed importance in international law—not only in legal theory, but also in history. From Martti Koskenniemi’s call for a ‘culture of formalism’ to China Miéville’s castigation of the ideology of the legal form, scholarship across the early 2000s sought to reinvigorate the distinction between ‘law’ and ‘not law’ as a vital contemporary question for the discipline. Nearly two decades on, this debate remains live, with Anne Orford now calling for a rejection of ‘neoformalism’ and the boundaries it sets on the possibilities of international legal history. In this chapter, I follow these formalism debates to show how they rest on different temporal frames: how conceptualisations of the past, present, and future of international law lead authors to situate themselves differently in relation to the question of form. In so doing, I aim to bring to the fore the importance of time and temporality for understanding wider developments in contemporary international legal thought
Plastic interactions with microbial communities in freshwater and estuarine environments
No full textPlastic pollution pervades ecosystems, creating novel microbial habitats, reshaping community structures, and disrupting biogeochemical cycles. Although estuarine and freshwater systems are now acknowledged as major plastic sinks, they remain largely understudied relative to marine environments, leaving critical gaps in understanding the interactions between plastics and microbial communities and their ecological consequences. This PhD thesis addresses two primary questions: (I) How do plastics interact with microbial communities in anoxic estuarine sediments? (II) Are plastic-microbe interactions influenced by eutrophication—another widespread anthropogenic stressor? First, a field survey across three estuaries compared microbial assemblages on buried plastics (the plastisphere) versus adjacent anoxic sediments. Plastic-associated communities were systematically distinct from sediment communities, with additional variation between sites. Despite these differences, the selective enrichment of sulfate-reducing and sulfur-oxidizing bacteria on plastics emerged as a recurring trend across estuaries. The biogeochemical consequences of these assemblages were then examined in 54-day anaerobic incubations using sediments from two estuaries and six polymer types. Throughout the incubations, CO₂ and sulfate concentrations were significantly altered in time-, polymer- , and site-specific ways, despite sediments remaining unaltered by plastic addition. The plastisphere exhibited dynamic temporal shifts, consistently diverging from sediment communities, suggesting a direct link between the observed impacts and microbial activity on plastics. Finally, large‐scale mesocosms were established to examine single and interacting effects of plastic-type and concentration and nutrient enrichment on freshwater microbiomes. Water microbiomes proved more responsive to plastic than sediment communities, and nutrient enrichment negated plastic-induced community shifts. Conventional plastics caused early, transient changes in communities, whereas PLA‐associated impacts emerged at later stages of the experiment. Overall, this work revealed that (i) the metabolic potential of plastispheres in anoxic sediments has been markedly underestimated, with local biogeochemical cycles being rapidly altered; (ii) plastic-related effects are modulated by co-occurring disturbances, underscoring the necessity for multifactorial approaches in plastic research
Correspondence regarding the article by Hüser et al. on "Critical care management of the patient with pharmaceutical poisoning".
No full textCOVID-19 transmission dynamics: age-specific patterns and super spreaders in South Korea.
No full textBACKGROUND: The global spread of COVID-19 has underscored the vital need for precise tracing of individuals involved in transmitting the virus through contact tracing. It is crucial to identify both those who spread the virus (infectors) and those who contract it (infectees) in order to gain a detailed understanding of the transmission dynamics. METHODS: We investigate age-specific infection patterns and their impacts by analyzing a unique dataset of the COVID-19 infection network in South Korea. In particular, we derive degree-based distributions from infection tree networks reconstructed through contact tracing of secondary infections, thereby identifying instances of Super Spreading Events (SSEs). Furthermore, we thoroughly examined age-specific infection networks using various metrics such as edge counting, entropy, density, and centrality. RESULTS: Our findings reveal systematic variations in age-specific COVID-19 patterns in South Korea. In particular, individuals aged 50 to 64 exhibit the highest centrality and number of connections within the COVID-19 infection network, underscoring their pivotal role in transmission dynamics. Moreover, the 20-49 age group consistently exhibited the lowest proportion of asymptomatic cases, in contrast to the higher rates observed among the 0-19 and 65≤ age groups. These results suggest that age groups differ not only in their structural positions within the transmission network but also in their clinical presentation, both of which are crucial for understanding the spread of infection. CONCLUSION: Analyzing age-specific infection networks is vital for clarifying transmission patterns and susceptibility across different age groups. Our study provides valuable evidence for identifying vulnerable populations and key cohorts that drive dissemination within the infection network. These insights can directly inform policy formulation, particularly in prioritizing vaccination strategies and tailoring age-targeted prevention measures. More broadly, this network-based approach offers a framework for designing effective control strategies against future emerging infectious diseases
