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Non-state legitimation as practice:the multiplicit making of public authority in Afro-Chinese engagements
Get PDFAfrican states, under market liberalization, have witnessed resurgent non-state intervention, with non-state actors (NSAs) enmeshed in collective good provision or roles associated with the state. To do so, NSAs must legitimate private forms of authority in the name of the public. Legitimation, we argue, is a core problem of socio-political life but remains only partially represented, hamstrung by Eurocentric, often state-based rationalities. This article sets out a post-Weberian framework for understanding how NGOs and companies legitimate their authority to act, focussing on African contexts. We bring analyses of these organizations into dialogue through our presentation of ‘the non/state’, attending to three conceptual axes: organizational type; source modalities; and contact zone. To illustrate the purchase of this approach, we explore a conspicuous ‘front’ in Africa’s international relations: Chinese organizations going global. Beyond notions of a singular, state-directed approach, we contribute to a pluralist understanding of ‘global China’, shaped by local contexts
Management of pregnancy in patients with rheumatic disease
No full textPregnancy in patients with inflammatory rheumatic diseases (IRMDs) presents unique challenges requiring multidisciplinary, individualized care. Historically associated with poor maternal and fetal outcomes, pregnancy in this population is now safer because of improved disease control and therapeutic strategies. However, risks vary by diagnosis and disease activity, with active disease at conception being a key predictor of adverse outcomes. Physiological changes during pregnancy, such as immune modulation, hormonal shifts and cardiovascular adaptations, can affect disease course and treatment decisions. Conditions such as systemic lupus erythematosus, antiphospholipid syndrome and systemic sclerosis require particular attention because of heightened risks of flares, thrombosis and poor fetal growth. Pre-conception counselling is essential to optimize disease stability, adjust medications and assess risk. Many conventional disease-modifying antirheumatic drugs and tumour necrosis factor inhibitors are safe for use in pregnancy and breastfeeding, while teratogenic agents such as methotrexate and mycophenolate must be discontinued in advance. Regular monitoring, including disease activity assessments and fetal surveillance, is vital throughout pregnancy. Postpartum disease flares are common and require proactive management. With appropriate planning and coordinated care, most women with IRMDs can experience successful pregnancies and healthy postpartum outcomes, highlighting the importance of balancing disease control with maternal and neonatal safety.<br/
Do early intervention services for psychosis maintain their effects after transition to usual/modular care? A systematic review and meta-analysis
No full textEarly intervention services (EIS) for psychosis have demonstrated superiority to usual care/modular care (UC/MC) until the end of their delivery. However, the maintenance effects of EIS care after transition to UC/MC are less clear. We aimed to compare these effects vs. UC/MC at least one year after the end of EIS care. This PRISMA and MOOSE-compliant systematic review searched PubMed, EMBASE, PsycINFO and Web of Science databases and Cochrane Central Register of Reviews, without time or language restrictions. We included studies initially designed as randomized controlled trials (RCTs) comparing EIS vs. UC/MC in patients with early-phase psychosis, in which both the intervention and control groups were followed for at least 12 months after cessation of EIS care in the intervention group. Co-primary outcomes were psychiatric hospitalization, duration of hospitalization, and drop-out at the end of follow-up (preferably 5 years post-EIS initiation). Secondary outcomes were severity of total, positive and negative symptoms; quality of life, work involvement, remission, legal offences, antipsychotic use, and suicide attempts. We meta-analyzed six RCTs with data from 13 papers, including 1,416 individuals (mean age: 23.9 years, females: 36.7%). After 2-3 years of receiving UC/MC, subsequent to 2-3 years of EIS care or UC/MC, individuals who originally received EIS care spent less days hospitalized than those continuing UC/MC (n=5, standardized mean difference, SMD=0.128, 95% CI: 0.019-0.237, p=0.021). However, although we confirmed the superiority of EIS care to UC/MC at the end of the intervention period (except for work involvement and legal offences), the two groups did not differ significantly at 2-3 years post-EIS care regarding hospitalization, all-cause drop-out, quality of life; severity of total, positive and negative symptoms; work involvement, remission, legal offences, antipsychotic use, and suicide attempts. In summary, EIS care did not maintain its superiority over UC/MC 2-3 years after its cessation across meta-analyzable outcomes, except for duration of hospitalizations. These results support the need to further develop and potentially extend full or individualized EIS delivery.</p
N05 Developing a Web-Based Intervention to Enhance Psychosocial Wellbeing and Resilience in Family Members of Individuals with Inflammatory Bowel Disease
No full textBackground: Family members of people living with inflammatory bowel disease (IBD) often experience uncertainty, emotional strain, and limited access to tailored information and support. Although earlier co-design work identified priority needs, few theory-informed, user-centred interventions exist to address the psychosocial and relational challenges faced by families. Therefore, this study aims to develop a theory-driven digital intervention -FamilyBridge for IBD -to enhance psychosocial wellbeing, support coping, and strengthen resilience among family members of individuals with IBD.Methods: Following the MRC framework for developing complex interventions [1], the development process was informed by a systematic review, qualitative interviews, and an initial co-design workshop. A behavioural analysis using COM-B and the Behaviour Change Wheel [2] identified target behaviours and suitable intervention functions. These were integrated with the Extended Common-Sense Model [3] and Family Systems Theory [4] to construct a programme theory and logic model. A multicomponent prototype was then created and refined through two stages: multidisciplinary expert consultation (IBD nursing, family therapy, Cognitive Behavioral Therapy, Information Technology, web designer) and end-user testing in a follow-up co-design workshop, where participants reviewed usability, relevance, and functionality.Results: Two behavioural targets: improving access to trusted IBD knowledge and increasing opportunities for peer support, informed the intervention design. The final platform comprises four psychoeducational modules, moderated peer-support spaces, lived-experience videos, self-care and caregiving toolkits, and signposting to credible resources. The logic model outlined two key mechanisms of change: a knowledge pathway (reducing uncertainty and strengthening illness understanding to improve coping and self-efficacy) and a peer-support pathway (emotional validation and shared coping to reduce isolation and enhance resilience). Expected outcomes include improved knowledge, coping, self-efficacy, support engagement, and resilience, with longer-term gains in wellbeing and reduced caregiver burden. Expert consultation and end-user testing informed refinements to usability, clarity, accessibility, and navigation.Conclusion: Through a structured, evidence-informed and stakeholder-driven process, FamilyBridge for IBD was developed as a comprehensive digital intervention supporting the psychosocial needs of families. Iterative refinement ensured theoretical coherence, clinical relevance, and strong user acceptability. The intervention is now ready for formal usability and feasibility testing.References:1. Skivington, K., et al., A new framework for developing and evaluating complex interventions: update of Medical Research Council guidance. BMJ, 2021. 374: p. n2061.2. Michie, S., L. Atkins, and R. West, The behaviour change wheel. A guide to designing interventions, 2014. 1: p. 1003-1010.3. Leventhal, H., I. Brissette, and E.A. Leventhal, The common-sense model of self-regulation of health and illness, in The self-regulation of health and illness behaviour. 2012, Routledge. p. 43-66.4. Bowen, M., The use of family theory in clinical practice. Comprehensive psychiatry, 1966. 7(5): p. 345-37
Misuse, Mislabelling, and the Broken Path of the ‘Hard-Right’:Challenging Non-scientific Political Discourse
No full textWhile ‘hard-right’ has gained traction in both scholarship and newsrooms, its conceptual vagueness and practical effects have remained under-examined. Drawing on Framing Theory and Agenda-Setting Theory, this article offers the first systematic, cross-publication study of how seven leading English-language outlets—The Guardian, BBC, Politico, The New Statesman, The Economist, Reuters and The Financial Times—employed the term between 2022 and 2025. A qualitative content analysis of 140 articles demonstrates that ‘hard-right’ functions as an umbrella label that conflates distinct far-right currents while framing devices selectively highlight certain traits and agenda-setting practices that elevate the term’s prominence in headlines and summaries. Although outlets vary in their use of contextual qualifiers, all exhibit comparable patterns of misclassification, label inflation and strategic ambiguity. It can be argued that the strategic use of vague terminology can soften the far-right’s image and bolster their electoral appeal. The findings demonstrate the urgency of adopting established political-science typologies and clearer editorial guidelines to safeguard analytical precision and democratic accountability in media coverage
Global, regional, and national burden of chronic respiratory diseases and impact of the COVID-19 pandemic, 1990–2023:a Global Burden of Disease study
No full textChronic respiratory diseases, including chronic obstructive pulmonary disease (COPD), asthma, pneumoconiosis, interstitial lung disease (ILD) and pulmonary sarcoidosis, are major global causes of mortality and morbidity. Although the COVID-19 pandemic has influenced acute respiratory health, its impact on chronic respiratory conditions remains unclear. We estimated the global, regional and national burden of chronic respiratory diseases from 1990 to 2023, including risk factors, and evaluated how these burdens have shifted during the COVID-19 pandemic using the Global Burden of Disease Study 2023. In 2023, chronic respiratory diseases accounted for 569.2 million (95% uncertainty interval (UI), 508.8–639.8) cases and 4.2 million (3.6–5.1) deaths. The age-standardized death rate declined by 25.7% globally from 1990 to 2023 despite an increase in ILD and pulmonary sarcoidosis. Mortality declined in younger males, especially for asthma, whereas older adults experienced a rise in ILD and pulmonary sarcoidosis. Smoking was the primary risk factor for COPD, whereas high body mass index and silica exposure were key risk factors for asthma and pneumoconiosis. During the pandemic, the incidence of chronic respiratory diseases increased modestly, but the decline in mortality rates became more pronounced, highlighting the need for sustained global attention and action to address their long-term burden
Long-term outcomes of abatacept in individuals at risk of developing rheumatoid arthritis (ALTO):a randomised, double-blind, placebo-controlled trial
No full textBackgroundClinical trials aimed at preventing rheumatoid arthritis in individuals at risk have had variable results. The long-term outcomes of disease interception, however, are not known. We aimed to examine the long-term effect of therapeutic intervention, with emphasis on efficacy and safety.MethodsThe Arthritis Prevention In the Preclinical Phase of Rheumatoid arthritis with Abatacept (APIPPRA) phase 2b, randomised controlled trial recruited 213 anti-citrullinated protein antibody (ACPA) positive individuals with arthralgia in 28 hospital-based early arthritis clinics in the UK and three in the Netherlands, randomly assigning participants to 52 weekly subcutaneous injections of 125 mg abatacept (n=110) or placebo (n=103), with another 52 weeks of follow-up. The APIPPRA Long-Term Outcome (ALTO) study extended follow-up for between 4 and 8 years and study participants and clinical assessors remained masked to treatment group. The primary outcome was the time from randomisation to development of clinical synovitis in at least three joints, rheumatoid arthritis according to American College of Rheumatology–European Alliance of Associations for Rheumatology 2010 criteria, or first treatment with disease modifying anti-rheumatic drugs, whichever was met first. The primary outcome was also stratified by autoantibody profiles defined at the time of randomisation. People with lived experience of rheumatoid arthritis had input into the APIPPRA study design. The study was registered at ISRCTN (ISRCTN-12680338), and is completed.FindingsBetween April 26, 2021, and Jan 31, 2023, 143 APIPPRA study participants enrolled in ALTO: 71 in the abatacept group and 72 in the placebo group (mean age 48·2 years [SD 11·2], 112 [78%] females, 31 [22%] males, 116 [81%] White). Median follow-up time from randomisation was 55 months (IQR 23–74). Primary events increased by 54 to 119. The initial between-group difference in restricted mean arthritis-free survival time observed at 2 years in APIPPRA remained significant at 4 years (4·9 months 95% CI 0·1–9·6; p=0·044), although the magnitude of this difference diminished over time. Assessments of disease activity and patient reported outcomes revealed no significant differences between groups beyond the treatment period. However, although participants with a broad autoantibody profile at baseline were at highest risk of progressing, this subgroup responded better to abatacept. There were 18 serious adverse events in the abatacept group and 13 in the placebo group; none deemed related to study drug.InterpretationIn this at-risk population, 1-year treatment with abatacept delayed progression to rheumatoid arthritis for up to 4 years. Those at highest risk of progression have a broad autoantibody profile but are more responsive to abatacept treatment
Artificial intelligence for arterial blood gas interpretation
No full textArterial blood gas (ABG) analysis is a fundamental diagnostic tool in clinical medicine, offering critical insights into a patient's respiratory and metabolic status. However, interpreting ABG results can be complex and time-sensitive, necessitating accurate and rapid analysis. With the advancement of artificial intelligence (AI), new avenues have emerged to enhance the interpretation and application of ABG data. This review explores the role of AI in ABG analysis, highlighting how machine learning algorithms and natural language models such as ChatGPT can aid in the systematic interpretation of complex physiological data. We examine the mechanisms through which AI systems analyze ABG parameters, including pH, PaCO₂, and HCO₃−, and provide diagnostic recommendations. Specific applications, such as AI-driven models, in the detection of COVID-19 severity and pulmonary hypertension via ABG data are discussed, demonstrating the expanding clinical utility of AI technologies. Additionally, we explore the potential of 3D animated computer models as educational and diagnostic tools for interpreting blood gas data. The integration of AI into ABG interpretation holds promise for improving diagnostic accuracy, clinical decision-making, and patient outcomes, signaling a transformative shift in modern healthcare diagnostics.</p
The Birth Trauma Earthquake:A qualitative investigation of first-time mothers who perceived their birth as traumatic
No full textProblem Pregnancies can be anxiety-provoking, and birth which includes complications or deviations from expectations can be perceived as traumatic. Background The perception of birth as traumatic is inherently subjective and the salience of aspects contributing to the perception of birth trauma amongst first-time mothers may differ. Further, risk factors have not included the voices of women from minority ethnic backgrounds, who are known to experience higher-levels of discrimination whilst in receipt of healthcare. Aim To contribute to the understanding of experiences of birth which are perceived as traumatic by women. Methods Semi-structured interviews (N = 16) were undertaken in May-June 2024 with mothers who had perceived their first birth to be traumatic; and analysed using Grounded Theory. Findings ‘The Birth Trauma Earthquake’ theory was comprised of six themes: ‘Morbid Fixations’; ‘Grieving the Birth They Never Had’; ‘Changing Relationships’; ‘The ‘Hysterical’ Labouring Woman’; ‘Transactional Care’; and ‘Diminishing Their Own Experiences’. Discussion Perceiving birth as traumatic was seen as a catalyst for rippling after-effects, with widespread impact both personally, and in their experience of healthcare professionals. Women were observed to have engaged in what may be perceived as maladaptive coping strategies to contain and control the associated shockwaves. Conclusion Maternity care should be comprehensive and compassionate, fostering resilience in the aftermath of the earthquake, but more importantly prepare and reduce the propensity for it. These findings provide an insight into the lived experience of those who have perceived birth to be traumatic, with implications for informing future methods to prevent and mitigate associated impacts.</p
