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Hepatology at home: a novel pathway for the integrated management of patients with liver disease in the home
Get PDFObjective: Hospital admissions and deaths due to liver disease are increasing worldwide, representing a significant burden on acute services. We describe the first 12 months of Hepatology at home, a novel service that delivers hospital-level care to patients with liver disease in their own home as an alternative to ambulatory or inpatient management. The primary aim was to evaluate the number of at-home days where a patient received assessment and management at home rather than attending hospital. Method: Processes of care and outcomes of patients referred to Hepatology at Home at Oxford University Hospitals NHS Foundation Trust, United Kingdom were collected prospectively for 12 months from 27 April 2024 to 26 April 2025. Results: 40 patients (n=16 female, median age 67) with 67 discrete episodes of care were referred. Most patients (90%) had cirrhosis associated with metabolic and/or alcohol risk factors. The most common reason for referral was the management of ascites/oedema (62.7%). Interventions performed in the home included ascitic tap (n=5), large volume paracentesis (n=5), venesection (n=6) and administration of intravenous iron, diuretics or antibiotics (n=13). Patients had an additional 269 days at home (per-patient median 5, range 1–72), of which 156 replaced inpatient hospital days and 113 replaced hospital-based ambulatory hepatology reviews. Within 30 days of discharge, 58.7% required a further Hepatology at home encounter or inpatient admission. The 30-day mortality rate was 32.5%. There were no unexpected deaths. Conclusion: Hepatology at Home is an alternative to hospital-based ambulatory or inpatient care for patients with liver disease
Mapping subnational gender gaps in internet and mobile adoption using social media data
Get PDFThe digital revolution has ushered in many societal and economic benefits. Yet access to digital technologies such as mobile phones and internet remains highly unequal, especially by gender in the context of low- and middle-income countries (LMICs). While national-level estimates are increasingly available for many countries, reliable, quantitative estimates of digital gender inequalities at the subnational level are lacking. These estimates, however, are essential for monitoring gaps within countries and implementing targeted interventions within the global sustainable development goals, which emphasize the need to close inequalities both between and within countries. We develop estimates of internet and mobile adoption by gender and digital gender gaps at the subnational level for 2,075 regions in 117 LMICs from 2015 through 2025, a context where digital penetration is low and national-level gender gaps disfavoring women are large. We construct these estimates by applying machine-learning algorithms to Facebook user counts, geospatial data, development indicators, and population composition data. We calibrate and assess the performance of these algorithms using ground-truth data from subnationally representative household survey data from 33 LMICs. Our results reveal striking disparities in access to mobile and internet technologies between and within LMICs. These disparities imply that as of 2025, women are 19% less likely to use the internet and 8% less likely to own a mobile phone in LMICs, corresponding to over 190 million fewer women owning a mobile phone and over 320 million fewer women using the internet
Potential drug targets for chronic widespread pain: a proteome-wide Mendelian randomization and drug repurposing analysis
Get PDFTesting the thermal physiology, habitat, and competition hypotheses for elevational range limits in four tropical songbirds
Get PDFRestricted elevational ranges are common across tropical montane species, but the mechanisms generating and maintaining these patterns remain poorly resolved. A longstanding hypothesis is that specialised thermal physiology explains these distributions. However, biotic factors such as habitat and interspecific competition have also been proposed to limit tropical species' elevational ranges. We combined point-level abundances, respirometry-based measurements of metabolic rate, habitat surveys, and playback experiments to simultaneously test these three hypotheses for four species of Central American cloud forest songbirds. Contrary to the physiological hypothesis, we found no evidence that thermoregulatory costs constrain species distributions. Instead, thermal conditions across each species' elevational range remained well within sustainable limits, staying ≤65% of hypothesised thresholds for tropical birds, even at the highest elevations. By contrast, we found some support for a combined role of habitat and competition in shaping elevational ranges. In one related species pair, the dominant lower-elevation species appears restricted by microhabitat, while the higher-elevation species is likely prevented from expanding downslope by the presence of this congener. Taken together, we conclude that thermoregulatory costs are an inadequate explanation for elevational range limits of tropical birds at our site, and suggest that biotic factors can be key in shaping these distributions
Structure, spectra, and intracluster chemistry of gas phase platinum nitrosyl ion-molecule complexes
Get PDFThe structures of gas-phase platinum – nitrosyl ion–molecule complexes, [Pt(NO)n] + (n =3-7), have been investigated using a combination of infrared photodissociation action spectroscopy and quantum chemical simulations. Nitric oxide binds in a combination of linear and bent motifs associated with nominal three- and one- electron donation, respectively, and there is clear evidence of a first solvation shell closing at six ligands. Oxygen rich complexes are also observed in the mass spectrum and their infrared spectra indicate formation of an N2O3 moiety. Calculations support the interpretation of [Pt(N2O3)(NO)n] + complexes arising from exothermic intracluster reactions in which [..(NO)3..]+ complexes form [..(NO2)(N2O)..]+ species from which the more weakly-bound nitrous oxide is lost
Explicating the complexity of self-illness ambiguity
Get PDFSelf-illness ambiguity (SIA) has been understood, roughly, as a difficulty in delineating one’s self from one’s mental illness. In this paper, we explicate some of the previously neglected complexity of SIA, by distinguishing two forms of the phenomenon: (a) identity-related SIA (‘How do I relate to my illness?’) and (b) agential SIA (‘Is it me or my illness that makes me act/think/feel a certain way?’). In addition, we differentiate general and particular varieties of these SIA-forms, as well as descriptive and analytic approaches to them. The resulting taxonomy allows (1) clarifying the growing SIA-literature, (2) supporting (self-)understanding in clinical contexts, and (3) drilling into the normatively significant features of SIA, e.g., enabling the better theorising of potential connections between agential SIA and questions of responsibility. Our taxonomy thus strengthens the conceptual foundation for future theories and applications of SIA
Indocyanine green (ICG) fluorescence guided lymph node mapping for determination of resection margins in colon cancer – ISCAPE trial
Get PDFBackground: Indocyanine green (ICG) lymphangiography for colon cancer has been regarded as a sentinel lymph node (LN) detection tool, but its repeatedly reported suboptimal sensitivity rates suggest that approach aiming to define locoregional lymphatic collector margins might be more efficient in guiding surgeon’s decision making. Thus, present study was designed to determine if sensitivity of the latter approach is sufficient to guide resection margins’ selection in colon cancer surgery. Methods: This is a prospective, single-centre, single-arm phase II interventional trial, including patients with histologically confirmed colon adenocarcinoma. ICG was injected subserosally in the beginning of operation, fluorescence was assessed 30 min after injection or later, when it became detectable. Primary endpoint was proportion of pN + patients in whom all metastatic lymph nodes were located within the area of fluorescence of lymphatics (AFL). Secondary endpoints included feasibility, safety, lymphatic spread patterns and proportion of resections modified based on ICG mapping. Results: Between 26 July 2022 and 27 February 2024, 101 patients underwent colectomies with intraoperative ICG lymphatic mapping. AFL was registered in all cases. Average lateral spread was 5.87 ± 3.20 proximally and 5.89 ± 2.54 cm distally. In two of 46 pN + cases affected LNs were discovered beyond AFL. ICG lymphatic mapping sensitivity was found to be 95.6%, which was beyond 0.960–0.990 interval, so null hypothesis was retained. Conclusions: In this trial, metastatic LNs were confined within ICG AFL in 95.6% of pN + cases. Although the predefined sensitivity threshold was not met, the result suggests potential for ICG mapping to guide resection margins in colon cancer surgery
The linguistic wants and needs of post-secondary Burmese refugees learning English as an additional language
Get PDFEducation for refugees has been a hotspot for research with increasing numbers of forced migration situations around the world, one of the long-lasting refugee migration situations is that of Burma. By exploring Burmese history and research related to refugee English education, large literature gaps have been found in relation to post-secondary Burmese students who are or were learning English. Through semi-structured interviews and their subsequent analysis, the linguistic wants and needs of three Burmese refugees learning English are explored, along with challenges they face in the learning process. The findings from interview analysis and comparison revealed that participants perceive relevant course material is crucial for school and communication, they expressed a desire to have started learning English from a younger age and prefer native English teachers for accent purposes – for understanding them and for attempting to acquire this accent. Participants also shared how tools for communicative needs, such as speech pace and comprehending advanced vocabulary, were the most difficult to acquire. The findings of this study can be used to help inform English educational practices for Burmese refugees on policy, classroom, or individual levels to ensure a higher quality of English learning
The informal diplomacies of Oswald Veblen
No full textSaunders Mac Lane described Oswald Veblen as a "mathematical statesman". Here we examine four episodes of Veblen's international statesmanship and extract from them a particular collection of personal qualities, interpersonal skills, and tools that characterize his effective mathematical diplomacy
Gender Inequalities and Motherhood Penalties across French and German Local Labor Markets
Get PDFThis data visualization examines the relationship between motherhood earnings penalties and gender earnings gaps across local labor markets in France and Germany. Drawing on harmonized administrative data, the authors document a strong positive association: regions with larger motherhood penalties tend to exhibit wider gender earnings gaps. This pattern holds across all Nomenclature of Territorial Units for Statistics second-division regions, where a 1 percent increase in the motherhood penalty corresponds to a 0.3 percent higher gender earnings gap. The relationship is even stronger within countries, with the average association rising to 0.7 percent. These findings suggest that regional differences in gender earnings inequality are strongly associated with the magnitude of motherhood penalties