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Procurement of the ITER magnets is due to start at the end of 2007/early 2008, with the launch of the longest lead time items, the Nb3 Sn conductor and the TF coil windings. The base design for procurement was established in 2001, and the build up of the Cadarache ITER team has been accompanied by a review of the most critical, or controversial, features of the 2001 design. At the same time, an urgent R&D program has been launched to complete the necessary verification of the design solutions that are proposed. In this paper an overview will be presented of the main design features and drivers, and some of the recent issues and R&D results will be summarized. [ABSTRACT FROM AUTHOR]

Aim and objectives. To identify evidence-based reports on the epidemiology of head injuries to develop guidelines for primary prevention activities by public health nurses. Background. Head injury is a major cause of morbidity, mortality, disability and lost years of productive life in the population under 40-45 years of age. Prevention strategies such as legislation on car seat belts, drink driving and health and safety at work have led to reductions in its incidence. As well as the personal repercussions for those injured and their families, there are resource implications for healthcare provision. There is a potential role for public health nurses in reducing this burden. Methods. A search of MEDLINE, PubMed, Science Direct, BNI and CINAHL was carried out for the period 1990-2005 using the keywords: head injury, brain injury, traumatic brain injury, head trauma, incidence, prevalence, epidemiology and prevention of head injuries. Results. Comparison of the data is difficult because of the use of different definitions of injury, criteria for severity, geographical bases and timeframes. Those at greatest risk seem to be young men and older people. The former are more implicated in traffic and work accidents and in physical violence, while older people are more susceptible to traffic accidents as pedestrians and to falls. The incidence in lower socio-economic groups is greater. Conclusions. The evidence-base for the primary prevention of head injury is weak. Standardized definitions and classification systems need to be used in future epidemiological studies to permit comparisons across studies. Relevance to clinical practice. There is a role for public health nurses in developing primary prevention campaigns in schools and local communities. Key target groups are young men and older people and campaigns need to tackle the particular issues relevant to these groups. [ABSTRACT FROM AUTHOR]

In this article the author presents a flow chart designed to assist nurses in providing evidence-based care of long term urinary catheters. The flow chart guides the nurse in making a proper assessment of the reason for urinary bypassing, blockage and non-drainage. The flow chart is intended to help identify a cause and to aid the practitioner in following a long term management plan. [ABSTRACT FROM AUTHOR]

The article presents an integrated dualist theory of punishment. The theory's assumption is that the road to a satisfactory account of punishment's justifiability should start by examining with seriousness the common point of departure already noted. A differentiation between core and peripheral cases of punishment is explored. It discusses the justification of punishment by analyzing justification.

Aim: This study explored young people's perceptions of their involvement in healthcare decisions affecting their management of care. Method: A phenomenological approach was used to allow in-depth examination of the young people's personal accounts of their experiences. Data were obtained from 10 hospitalised young people between the ages of 12-16 years from both genders and from different medical and surgical specialities using focused interviews. Transcribing, reading and listening to the data enabled data analysis through reflection and analysis. Findings: Three themes were identified: level of involvement in decision-making; psychological impact of involvement in decision making; and communication. Conclusion: Professional practice in the care of young people should include effective communication, a policy of inclusion and active assessment of competence. [ABSTRACT FROM AUTHOR]

The author asserts that the debate over originalism presented by Jack Balkin concerns whether constitutional interpretation must be a search for the original understanding or intent. He examines whether the correct meaning of the constitution can change even absent constitutional amendment. Jack Balkin says that interpretation is influenced by social movements over interpretation by judges. Balkin's reasons for concluding that the originalist answer is better than the non-originalist answer rather than that the two answers should be studied.

Abstract: The ITER magnets are a complex system involving interfaces between many advanced technologies (superconductors, forging/welding/machining of massive structures, cryogenics, composites and moulding, high voltage electrical), yet at the same time form part of the ITER ‘basic machine’ which is required to operate at the design parameters, broadly failure free, for the design life of the tokamak. This imposes special quality control problems for the ITER project integration by the ITER International Team (IT) through the design, fabrication and operation. The magnets are not a test bed for new technology but in spite of this must use it, successfully. There is little previous experience of such a system but full functionality is required from the start, with limited opportunity for adjustment. And, finally, costs and schedule must be contained. The procurement strategy for the machine, with magnet components being supplied ‘in kind’, requires particular attention to the specifications, scheduling and quality control (QC). Special issues here are the testing requirements on magnet components, especially before final installation but also at critical intermediate stages. Unnecessary or ineffective quality control procedures cause delay and high costs, and divert attention from critical items. The main points of the magnet QC programme are summarised, including the use of codes and standards, qualification, manufacturing quality assurance, commissioning and in-service inspection. [Copyright &y& Elsevier]

The problem of how representative a short Nb3Sn conductor sample is for simulating conductor-in-coil conditions in the ITER magnets is addressed here by considering the particular case of the Central Solenoid Model Coil (CSMC), tested in 2001-2003 at JAERI Naka, Japan, and its associated Good Joint IGJ) sample (tested in 1999 in the SULTAN facility). While the basic thermal-hydraulic conditions are interpreted from experimental data by the M&M code, the sensitivity of the voltage-temperature characteristics to mechanical effects (due to the strain sensitivity of the Nb3Sn) is investigated by analysis. The results are used to assess the errors to be expected in predicting coil performance from measurements made on conductor samples. [ABSTRACT FROM AUTHOR]

Objectives: To determine the short-term effects of cardiac resynchronization therapy (CRT) on measurements of left ventricular (LV) diastolic function in patients with severe heart failure. Background: Cardiac resynchronization therapy improves systolic performance; however, the effects on diastolic function by load-dependent pulsed-wave Doppler transmitral indices has been variable. Methods: Fifty patients with severe heart failure were evaluated by two-dimensional Doppler echocardiography immediately prior to and 4 ± 1 month after CRT. Measurements included LV volumes and ejection fraction (EF), pulsed-wave Doppler (PWD)-derived transmitral filling indices (E- and A-wave velocities, E/A ratio, deceleration time [DT], diastolic filling time [DFT], and isovolumic relaxation time). Tissue Doppler imaging was used for measurements of systolic and diastolic (Em) velocities at four mitral annular sites; mitral E-wave/Em ratio was calculated to estimate LV filling pressure. Color M-mode flow propagation velocities were also obtained. Results: After CRT, LV volumes decreased significantly (p < 0.001) and LVEF increased >5% in 28 of 50 patients (56%) and were accompanied by reduction in PWD mitral E-wave velocity and E/A ratio (both p < 0.01), increased DT and DFT (both p < 0.01), and lower filling pressures (i.e., E-wave/Em septal; p < 0.01). Patients with LVEF response ≤5% after CRT had no significant changes in measurements of diastolic function; LV relaxation (i.e., Em velocities) worsened in this group. Conclusions: In heart failure patients receiving CRT, improvement in LV diastolic function is coupled to the improvement in LV systolic function. [Copyright &y& Elsevier]

Abstract: The manufacturing of Nb3Sn strands, with drawing and annealing of multifilamentary strands followed by a heat treatment at about 900K to form the Nb3Sn by reaction of tin and niobium, has the potential to create a complex internal stress system. The strain sensitivity of the Nb3Sn superconducting properties makes prediction of the internal stresses a necessary step to understanding the performance of Nb3Sn conductors under the magnetic load conditions experienced in a coil. An elasto-plastic one dimensional finite element model, including temperature dependent stress–strain curves, annealing and manufacturing process stresses, is used to derive the internal stresses of Nb3Sn strands. The model is benchmarked against a range of experimental data, including stress–strain tensile tests, superconducting critical current–strain tests, and length changes through heat treatment and through a 4K thermal cycle. The model can predict all the experimental features and shows a number of unexpected conclusions regarding the origin of the Nb3Sn stresses. [Copyright &y& Elsevier]

The effect of applied and thermal strain on the superconducting performance of Nb3Sn strands is well known. Prediction of the strand performance depends on an accurate knowledge of the strand strain state. As well as operating strains due to mechanical loads on the conductor, the strand has a complex system of internal strains due to the fabrication process and partial annealing at the reaction heat treatment temperature (about 600 C). Nb3Sn strands are now available with a range of different matrices around the superconducting filaments, varying both in mechanical properties and geometry. Starting from a database of mechanical properties, this paper will use finite element analysis to model the elasto-plastic behavior of the matrix, predicting the filament multi-axial strain state. [ABSTRACT FROM AUTHOR]

Discusses the concept of partisan gerrymandering in the U.S. History and legal landscape of gerrymandering; Definition of excessive partisanship; Information on the doctrine of partisan gerrymandering.

In the design of CIC conductors using NbTi or Nb3Sn strands cooled with supercritical He, the choice of stability criteria for near steady state operation presents a problem. The disturbances are small, under 10 mJ/cm³ of cable material, too small for design significance. The main parameters affected by the choice of stability criteria are temperature margin and Cu:nonCu ratio, both of which strongly affect cable cost and overall current density. Methods quantifying the copper required for stability have been elementary, mostly using cryogenic stability (the well-cooled condition). Recent experimental and analytical work on the electric field achieved before quench Eq suggest a more exact method. Cable quench is modeled by a simple stability simulation, including copper conduction and the superconducting transition. A heat transfer coefficient is derived from ITER model coil data. As an example it is applied to conductor design (Fig. 1) for the ITER fusion reactor magnets. [ABSTRACT FROM AUTHOR]

For generations, American constitutional theorists and judges have struggled with problems of constitutional interpretation, exploring how meaning is properly derived from the Constitution and, in so far as the answer may be different, how courts ought to derive such meaning. Recent years, however, have seen an upsurge in scholarship addressed to a related but distinct subject. Without entirely abandoning debates over constitutional interpretation, constitutional theorists have started increasingly to wonder about those judicial outputs that feature in the enterprise of constitutional adjudication and yet are something other than a court's determination as to what any given provision of the Constitution means. Theorists have turned their attention from constitutional meaning to what they may call, at least on a first pass, constitutional doctrine.

The strand voltage–current (V–I) characteristic has long been studied as part of the development of low temperature superconducting strands, often being used as a measure of the ‘quality’ of the individual filaments. However, the behaviour of the V–I characteristic when the strands are included in cables, and its effect on the overall cable behaviour, have not received so much attention. Two analyses are developed, one to illustrate how the strand V–I characteristic can be influenced by cable effects and, in an interaction in the reverse direction, one to show how the V–I characteristic of the strand can determine the limiting cable performance. [Copyright &y& Elsevier]

: ObjectivesWe evaluated in humans the safety and efficacy of a novel magnetic guidance system (MGS) for electrophysiological mapping, pacing, and ablation.: BackgroundCatheter ablation of atrial fibrillation and other complex arrhythmias requires precise catheter manipulation and stabilization. We have shown in animals that the MGS can precisely manipulate a mapping catheter within the heart with an external magnetic field rather than manual catheter control.: MethodsThirty-one adults referred for diagnostic electrophysiology studies were enrolled in a prospective trial of the MGS. The magnetic catheter was navigated to preselected sites in the right atrium (RA) and right ventricle (RV) in the first 20 patients. Electrograms were recorded at each target site, and pacing thresholds were measured. In a subset of five patients, RA and RV electrograms and stimulation thresholds were recorded with both a standard ablation catheter and the magnetic catheter. Eleven additional patients were recruited for supraventricular tachycardia (SVT) mapping, and seven of these underwent ablation.: ResultsNavigation was successful in 200 of 202 predetermined right-sided navigation targets and 13 of 13 targets in the left atria. Pacing thresholds and electrogram amplitudes in the RA and RV were not significantly different between the standard and magnetic catheters. The SVT mapping with the magnetic catheter was successful in 13 patients, including 4 with left-sided accessory pathways. The MGS was used for successful ablation of SVT in seven of seven patients. There were no procedural complications.: ConclusionsThese results demonstrate that the MGS can be used for intracardiac mapping, pacing, and ablation safely and effectively. [Copyright &y& Elsevier]

Anglo-American theorists of the criminal law have concentrated on-one is tempted to say "obsessed over"-the distinction between justification and excuse for a good quarter-century and the scholarly attention has purchased unusually widespread agreement. Justification defenses are said to apply when the actor's conduct was not morally wrongful; excuse defenses lie when the actor did engage in wrongful conduct but is not morally blameworthy. A near consensus thus achieved, theorists have turned to subordinate matters, joining issue most notably on the question of whether justifications are "subjective"-turning upon the actor's reasons for acting-or "objective"-involving only facts independent of the actor's beliefs and motives. This Article seeks to demonstrate that the prevailing understanding is wrong. Drawing on the well-known distinction between conduct rules and decision rules, it argues that the distinction between justification and excuse, for purposes of a criminal law taxonomy, is only this: A justified action is not criminal, whereas an excused defendant has committed a criminal act but is not punishable. To readers only marginally acquainted with the relevant literature, this claim may seem far from extravagant, for occasional statements to the same effect can be found in the case law and commentary. In fact, however, theorists have not appreciated just how this articulation of the distinction differs from the orthodox one, nor what consequences follow. This Article attempts to remedy that defect. One lesson of a systematic investigation into these competing formulations is that the long-running debate over whether justifications, properly understood, are "subjective" or "objective" is misconceived. This is a debate over policy broadly conceived, not (as it so often purports to be) a matter of conceptual analysis. More generally, this Article's examination of justification and excuse constitutes a case study in the complex relationship between legal and moral reasoning, and highlights the importance of distinguishing arguments that advance substantive value judgments from those that purport to analyze our conceptual apparatus. It may be that conceptual analysis is no less contestable or value-laden than is substantive normative argument (though perhaps it is). In any event, they are not the very same enterprise and a first step to clear thinking-in the criminal law and elsewhere-is to keep them distinct. [ABSTRACT FROM AUTHOR]

Testing of the five International Thermonuclear Experimental Reactor (ITER) model coils is nearly complete and it is possible to produce an overall summary of the conductor performance assessment. The interpretation is supported by a large database of tests on components (especially strand) and by analysis of the two main phenomena that influence the strand performance in the cable (current non-uniformity and mechanical loads). Individually, interpretation of individual coils is difficult but taken together the results enable conclusions to be drawn about the expected behaviour of conductors in the ITER coils. The conductor design has successfully resolved many of the problems of stability and pulsed current behaviour associated with large multi-strand cables, and the performance is better than expected in these areas. The current sharing behaviour is below expectations, probably due to an extra unexpected strain effect in the Nb3Sn strands arising from the local magnetic loads, and the paper concentrates on this issue. Design modifications are required to recover the performance and updated design criteria to implement these are proposed. [Copyright &y& Elsevier]

Recent electromagnetic analyses of Nb3Sn cables have suggested that cyclic longitudinal bending strain due to transverse magnetic loads could explain the observed low ‘n’ values and drop in critical current compared to the strand. The paper uses finite element modelling to simulate the strand strain states in the cable, including friction and plasticity effects (which cause permanent strand bending). These results are used to calculate the expected behaviour of the overall cable and of strands extracted from the cable after experiencing operational loads. Comparisons with experimental results are made. [Copyright &y& Elsevier]

The full set of TCS measurements performed during 2000–2002 on conductor 1A of the ITER Central Solenoid Model Coil (CSMC) of the International Thermonuclear Experimental Reactor (ITER) is analysed with the extensively validated M&M code. Under the assumptions of uniform strand properties and uniform current distribution among strands, the performance of this “average” strand in the cable is deduced from the best fit of the measured voltage–inlet temperature characteristics. Two fitting parameters are chosen: an ad-hoc additional contribution ‘&epsiv;extra’ to the longitudinal strain of the average strand in the cable, and the average-strand (or cable “effective”) index ‘n’ of the electric field–current density characteristic. It is shown that the average strand in the CSMC performed less well than expected from the strand database––an increasingly negative &epsiv;extra being needed to reproduce the coil behaviour at increasing transport currents, and that the cable effective n is clearly below the measured n of the strand. It is argued that this average-strand performance reduction in the CSMC is most likely related to mechanical load effects. [Copyright &y& Elsevier]

Examines the ruling of the U.S. Supreme Court under chief justice William Rehnquist on the case South Dakota versus Dole, which deals with federal spending. Background of the case; Laws and facts being disputed in the case; Argument taken by the Supreme Court for its decision.

This report summarizes the deliberations of a multidisciplinary committee, sponsored by the Pharmaceutical Research and Manufacturers of America, on current “best practices” within the U.S. pharmaceutical industry in assessing the role of drug metabolites as potential mediators of the toxicity of new drug products. Input to the document was obtained from numerous sources, including members of the pharmaceutical industry, academic investigators, and representatives of regulatory agencies who attended a workshop on the subject in November 2000. The overall goal of the paper is to define practical and scientifically based approaches to the use of metabolite data that address contemporary issues in the safety evaluation of drug candidates. Although there remains a lack of consensus on how best to deal with several aspects of this complex subject, this paper raises a number of points to consider, which emphasize the need to treat drug metabolite issues on a case-by-case basis. It is hoped that the discussion will promote continued dialog among industrial scientists and regulators charged with ensuring the clinical safety of new therapeutic agents. [Copyright &y& Elsevier]

Assessment of measured values of the mechanical stiffness of Nb3Sn cable-in-conduit conductors (CICC) suggests that longitudinal strand bending due to local magnetic loads, transverse to the conductor axis, is sufficiently high to affect the superconductor performance when the magnetic field is over about 10 T. A current diffusion model is applied to simulated current transfer between filaments inside a Nb3Sn strand in a cable during a Tcs (ramped temperature at constant current) measurement. It can be shown that the effect of cyclic bending strains along such strands, with a characteristic wavelength of about 5 mm, can be to produce a drop in the effective `n'' value (the power factor in the voltage–current relation) of the strand as it starts to enter the current sharing region, for electric fields up to 100 μV/m, from 30 to under 10. The effect is dependent on the internal resistivity of the strands as well as the bending strain distribution, but estimates suggest that for transverse resistivity ranges typical of Nb3Sn strands, both the `n'' value can be reduced and/or the eventual voltage runaway point can decrease. Strands with a high mean stress level (as is expected with a steel jacket) are predicted to be more sensitive than those operating near zero mean intrinsic strain (as with an incoloy or titanium jacket). Although clearly not the only factor, this effect could explain recent experimental results on large coils as well as short conductor samples, where unexpectedly low cable `n'' values have been found. By providing a link between strain and `n'', it also suggests a mechanism by which current (and hence magnetic load) cycling can affect the superconducting performance, as observed in some recent tests. [Copyright &y& Elsevier]

Focuses on the statutory advertising ban and implementing regulations of casino gambling in Puerto Rico. Prohibitions on the use of the word 'casino' on matchbooks and interoffice correspondence; Application of the mid-level scrutiny for regulations of commercial speech; Advancement in the substantial governmental interest in reducing demand for casinos.

Examines the causes for the premature voltage development of superconducting magnet central solenoid insert coil. Variation of strand current and field; Nonuniform current distribution; Self-magnetic field effects.

Discusses the unconstitutional dimensions of coercive proposals under the Twenty-First Amendment to the United States Constitution. Description of the conditional offer problem; Dimensions of constitutional violation; Key components to appraise the constitutionality of individual conditional governmental proposals; Analysis on the several United States Supreme Court cases dealing with the issue.

Focuses on the application of the federal intellectual property law on the case of Florida Prepaid Postsecondary Education Expense Board versus College Savings Bank. History of the United States Supreme Court's state sovereign immunity doctrine; Impact of state intellectual property violations on foreign affairs; Conclusion.

Presents an analysis of the impact of strand joints and copper location on the current distribution and stability in cable-in-conduit conductors. Use of a time dependent model of current diffusion and heat transfer; Contribution to cable stability by separate copper strands; Current ramping with joined strands; Effects of separate copper strands.

Describes the design of the Nb[sub 3]Sn and NbTi cable-in-conduit conductors of the International Thermonuclear Experimental Reactor magnets. Optimization of the amount of superconducting strand; Conductor thermohydraulic analysis; Consideration of non-uniform current distribution among superconducting strands; Conductor design rules; Heat deposition; Conductor parameters.

Focuses on the predicted thermohydraulic performance of the International Thermonuclear Experimental Reactor Central Solenoid Model Coil in Japan. Expected cable performance; Simulation of the conductor performance; Possible increase in conductor temperature; Correlation of strand and conductor data base with thermohydraulic behavior.

Cells expressing features of senescence, including upregulation of p21 and p16, appear transiently following tissue injury, yet the properties of these cells or how they contrast with age-induced senescent cells remains unclear. Here, we used skeletal injury as a model and identified the rapid appearance following fracture of p21+ cells expressing senescence markers, mainly as osteochondroprogenitors (OCHs) and neutrophils. Targeted genetic clearance of p21+ cells suppressed senescence-associated signatures within the fracture callus and accelerated fracture healing. By contrast, p21+ cell clearance did not alter bone loss due to aging; conversely, p16+ cell clearance, known to alleviate skeletal aging, did not affect fracture healing. Following fracture, p21+ neutrophils were enriched in signaling pathways known to induce paracrine stromal senescence, while p21+ OCHs were highly enriched in senescence-associated secretory phenotype factors known to impair bone formation. Further analysis revealed an injury-specific stem cell–like OCH subset that was p21+ and highly inflammatory, with a similar inflammatory mesenchymal population (fibro-adipogenic progenitors) evident following muscle injury. Thus, intercommunicating senescent-like neutrophils and mesenchymal progenitor cells were key regulators of tissue repair in bone and potentially across tissues. Moreover, our findings established contextual roles of p21+ versus p16+ senescent/senescent-like cells that may be leveraged for therapeutic opportunities. [ABSTRACT FROM AUTHOR]

Conservation reintroductions play a vital role in the recovery of threatened species, and clear goals and objectives are essential for evaluating their effectiveness. In this study, we assessed short‐term success (<18 months) of trial reintroductions of the Extinct in the Wild blue‐tailed skink (Cryptoblepharus egeriae) and Lister's gecko (Lepidodactylus listeri) on Christmas Island. Our evaluation criteria focused on body condition, reproduction, habitat suitability, survival and population growth. In 2018 and 2019, 170 C. egeriae and 160 L. listeri were translocated from a local captive breeding facility to a 2600 m2 outdoor fenced enclosure designed to exclude a predatory snake. Despite body condition declining immediately following release for both species, it had improved by 6 months post‐release. We also detected successful reproduction in both species. Apparent survival was high for C. egeriae but low for L. listeri, and population growth was only evident in C. egeriae. We were unable to determine whether low survival of L. listeri in the release site was due to high post‐release dispersal (beyond the exclosure) or mortality. Both species selected habitats that contained high rock and log cover and avoided areas with low ground cover. Appropriate assessment criteria, as utilized in this study, enable objective and timely evaluations of reintroduction success, thereby facilitating the improvement and refinement of reintroduction protocols. Our study showed that C. egeriae can establish (in the short‐ to medium‐term) in a site from which a principal threat has been excluded and undergo rapid population growth, whereas under current conditions L. listeri cannot. However, we also demonstrate that such medium‐term success may not lead to long‐term success, as the rapid increase in C. egeriae population was reversed between 29 and 31 months after release because the barrier used to exclude an invasive predator, the wolf snake (Lycodon capucinus), was breached. [ABSTRACT FROM AUTHOR]

Variation in response to the Guignard pictate test may be detected within wild British populations of Brassica oleracea L. subsp. oleracea. Plants with the greatest reaction are the least frequent. In different seasons, individuals react differently to the test, possibly in response to temperature fluctuations. In B. oleracea the picrate test is perhaps responding to allyl derivatives of the glucosinolate sinigrin; HCN was not detected. [ABSTRACT FROM AUTHOR]

The possible involvement of flavour volatiles in the resistance of Brassica oleracea L. seedlings to cabbage downy mildew (Peronospora parasitica (Pers. ex Fr.) Fr.) was investigated using seedlings of a number of commercial Brassica oleracea cultivars. Flavour volatiles are primarily released as a result of tissue damage in brassicas. Only one cultivar tested was resistant to the disease and its tissue maccrates yielded the greatest concentration of volatiles. One of these compounds, allyl isothiocyanate, proved to be highly toxic to the pathogen and was produced in much greater concentrations in maccrates of cotyledon than first leaf tissue. The ability of seedlings to produce ally! isothiocyanate in large amounts following tissue damage may inhibit the growth of Peronospora parasitica in resistant seedlings. Wild populations of Brassica oleracea L. subsp. oleracea (wild cabbage) were also tested for disease resistance, and the highest proportions of resistant seedlings were found in those populations containing high levels of flavour volatiles. The longest established wild populations possessed the highest average concentrations of flavour volatiles, and it is suggested that selective breeding has resulted in a reduction in the amounts of these compounds in cultivated forms. This change may be a contributory factor towards the lack of resistance shown by modern cultivars. [ABSTRACT FROM AUTHOR]

Discusses electric conductor design for international tokamak engineering reactor (ITER). Operating conditions; Design criteria and operating limits; Design optimisation; Conclusions.

Proposes a theory called `evidentiary theory of blackmail,' which purports to justify the reason for criminalizing blackmail. Discussion on the controversy of blackmail as a crime among legal scholars and philosophers; Examination of the various theories that tackles the controversy of blackmail as a criminal act.

People with HIV (PWH) are at elevated risk for suicidal ideation (SI), yet few studies have examined how substance use, clinical and sociodemographic factors are associated with SI among PWH. We used substance use (Tobacco, Alcohol, Prescription Medication, and Other Substance Use [TAPS]) and depression (PHQ-9) data from computerized screening of adult PWH in primary care clinics in Northern California, combined with health record data on psychiatric diagnoses, HIV diagnosis, treatment, and control (HIV RNA, CD4), insurance, and neighborhood deprivation index (NDI) to examine factors associated with SI (PHQ-9 item 9 score > 0). Adjusted odds ratios (aOR) for SI were obtained from logistic regression models. Among 2829 PWH screened (92 % male; 56 % white; mean (SD) age of 54 (13) years; 220 (8 %) reported SI. Compared with no problematic use, SI was higher among those reporting one (aOR = 1.65, 95 % CI = 1.17, 2.33), two (aOR = 2.23, 95 % CI = 1.42, 3.49), or ≥ 3 substances (aOR = 4.49, 95 % CI = 2.41, 8.39). SI risk was higher for those with stimulant use (aOR = 3.55, 95 % CI = 2.25, 5.59), depression (aOR = 4.18, 95 % CI = 3.04, 5.74), and anxiety diagnoses (aOR = 1.67, 95 % CI = 1.19, 2.34), or Medicaid (aOR = 2.11, 95%CI = 1.24, 3.60) compared with commercial/other insurance. SI was not associated with HIV-related measures or NDI. SI was assessed with a single PHQ-9 item. Simultaneous SI and exposure data collection restricts the ability to establish substance use as a risk factor. HIV care providers should consider multiple substance use, stimulant use, depression or anxiety, and public insurance as risk factors for SI and provide interventions when needed. • People with HIV (PWH) are at elevated risk for suicidal ideation (SI). • Computerized screening in primary care can help identify those at risk. • SI risk increased with greater number of substances patients reported using. • Stimulant use, depression, anxiety, and public insurance were associated with SI. • Providers should assess key risk factors to address SI among PWH. [ABSTRACT FROM AUTHOR]

Background This study presents guidelines for implementation distilled from the findings of a realist evaluation. The setting was local health districts in New South Wales, Australia that implemented three clinical improvement initiatives as part of a state-wide program. We focussed on implementation strategies designed to develop health professionals’ capability to deliver value-based care initiatives for multisite programs. Capability, which increases implementers’ ability to cope with unexpected scenarios is key to managing change. Methods We used a mixed methods realist evaluation which tested and refined program theories elucidating the complex dynamic between context (C), mechanism (M) and outcome (O) to determine what works, for whom, under what circumstances. Data was drawn from program documents, a realist synthesis, informal discussions with implementation designers, and interviews with 10 key informants (out of 37 identified) from seven sites. Data analysis employed a retroductive approach to interrogate the causal factors identified as contributors to outcomes. Results CMO statements were refined for four initial program theories: Making it Relevant– where participation in activities was increased when targeted to the needs of the staff; Investment in Quality Improvement– where engagement in capability development was enhanced when it was valued by all levels of the organisation; Turnover and Capability Loss– where the effects of staff turnover were mitigated; and Community-Wide Priority– where there was a strategy of spanning sites. From these data five guiding principles for implementers were distilled: (1) Involve all levels of the health system to effectively implement large-scale capability development, (2) Design capability development activities in a way that supports a learning culture, (3) Plan capability development activities with staff turnover in mind, (4) Increased capability should be distributed across teams to avoid bottlenecks in workflows and the risk of losing key staff, (5) Foster cross-site collaboration to focus effort, reduce variation in practice and promote greater cohesion in patient care. Conclusions A key implementation strategy for interventions to standardise high quality practice is development of clinical capability. We illustrate how leadership support, attention to staff turnover patterns, and making activities relevant to current issues, can lead to an emergent learning culture. [ABSTRACT FROM AUTHOR]

Background: Implementation research is increasingly being recognised for optimising the outcomes of clinical practice. Frequently, the benefits of new evidence are not implemented due to the difficulties applying traditional research methodologies to implementation settings. Randomised controlled trials are not always practical for the implementation phase of knowledge transfer, as differences between individual and organisational readiness for change combined with small sample sizes can lead to imbalances in factors that impede or facilitate change between intervention and control groups. Within-cluster repeated measure designs could control for variance between intervention and control groups by allowing the same clusters to receive a sequence of conditions. Although in implementation settings, they can contaminate the intervention and control groups after the initial exposure to interventions. We propose the novel application of counterbalanced design to implementation research where repeated measures are employed through crossover, but contamination is averted by counterbalancing different health contexts in which to test the implementation strategy.Methods: In a counterbalanced implementation study, the implementation strategy (independent variable) has two or more levels evaluated across an equivalent number of health contexts (e.g. community-acquired pneumonia and nutrition for critically ill patients) using the same outcome (dependent variable). This design limits each cluster to one distinct strategy related to one specific context, and therefore does not overburden any cluster to more than one focussed implementation strategy for a particular outcome, and provides a ready-made control comparison, holding fixed. The different levels of the independent variable can be delivered concurrently because each level uses a different health context within each cluster to avoid the effect of treatment contamination from exposure to the intervention or control condition.Results: An example application of the counterbalanced implementation design is presented in a hypothetical study to demonstrate the comparison of 'video-based' and 'written-based' evidence summary research implementation strategies for changing clinical practice in community-acquired pneumonia and nutrition in critically ill patient health contexts.Conclusion: A counterbalanced implementation study design provides a promising model for concurrently investigating the success of research implementation strategies across multiple health context areas such as community-acquired pneumonia and nutrition for critically ill patients. [ABSTRACT FROM AUTHOR]

Sea turtles are vulnerable to climate change since their reproductive output is influenced by incubating temperatures, with warmer temperatures causing lower hatching success and increased feminization of embryos. Their ability to cope with projected increases in ambient temperatures will depend on their capacity to adapt to shifts in climatic regimes. Here, we assessed the extent to which phenological shifts could mitigate impacts from increases in ambient temperatures (from 1.5 to 3°C in air temperatures and from 1.4 to 2.3°C in sea surface temperatures by 2100 at our sites) on four species of sea turtles, under a "middle of the road" scenario (SSP2‐4.5). Sand temperatures at sea turtle nesting sites are projected to increase from 0.58 to 4.17°C by 2100 and expected shifts in nesting of 26–43 days earlier will not be sufficient to maintain current incubation temperatures at 7 (29%) of our sites, hatching success rates at 10 (42%) of our sites, with current trends in hatchling sex ratio being able to be maintained at half of the sites. We also calculated the phenological shifts that would be required (both backward for an earlier shift in nesting and forward for a later shift) to keep up with present‐day incubation temperatures, hatching success rates, and sex ratios. The required shifts backward in nesting for incubation temperatures ranged from −20 to −191 days, whereas the required shifts forward ranged from +54 to +180 days. However, for half of the sites, no matter the shift the median incubation temperature will always be warmer than the 75th percentile of current ranges. Given that phenological shifts will not be able to ameliorate predicted changes in temperature, hatching success and sex ratio at most sites, turtles may need to use other adaptive responses and/or there is the need to enhance sea turtle resilience to climate warming. [ABSTRACT FROM AUTHOR]

We characterized polysubstance use burden and associations with mental health problems across demographic subgroups of PWH. In 2018–2020, as part of a primary care-based intervention study, PWH in care at three medical centers in Kaiser Permanente Northern California were screened for depression (PHQ-9≥10), anxiety (GAD-2≥3), and substance use (Tobacco, Alcohol, Prescription medication, and other Substance use [TAPS]≥1 per substance). We used Poisson regression to estimate prevalence ratios (PRs) comparing polysubstance use prevalence (TAPS≥1 for ≥2 substances) between PWH with positive screens for depression or anxiety vs. neither, among all PWH, and stratified by race/ethnicity and age (restricted to men), adjusting for sociodemographics, CD4, and HIV load. Screened PWH (N = 2865) included 92% men, 56% White, 19% Black, and 15% Hispanic PWH, with a median age of 55 years. Overall, polysubstance use prevalence was 26.4% (95% CI 24.9%-28.1%). PWH with depression or anxiety (n = 515) had an adjusted polysubstance use PR of 1.26 (1.09–1.46) vs. PWH with neither (n = 2350). Adjusted PRs were 1.47 (1.11–1.96), 1.07 (0.74–1.54), and 1.10 (0.85–1.41) among Black, Hispanic, and White men, respectively. Adjusted PRs did not differ by age group. Interventions should consider jointly addressing mental health and substance use problems and potential drivers, e.g. stigma or socioeconomic factors. [ABSTRACT FROM AUTHOR]

Background Rapid antiretroviral therapy (ART) is the recommended treatment strategy for patients newly diagnosed with HIV, but the literature supporting this strategy has focused on short-term outcomes. We examined both long-term outcomes and predictors of rapid ART among patients newly diagnosed with HIV within an integrated health care system in Northern California. Methods This observational cohort study included adults newly diagnosed with HIV between January 2015 and December 2020 at Kaiser Permanente Northern California. Rapid ART was defined as ART initiation within 7 days of HIV diagnosis. We collected demographic and clinical data to determine short-term and long-term outcomes, including viral suppression, care retention, medication adherence, and cumulative viral burden. Logistic regression models were used to identify predictors of rapid ART initiation. Results We enrolled 1409 adults; 34.1% initiated rapid ART. The rapid ART group achieved viral suppression faster (48 vs 77 days; P <.001) and experienced lower cumulative viral burden (log10 viremia copy-years, 3.63 vs 3.82; P <.01) but had slightly reduced medication adherence (74.8% vs 75.2%; P <.01). There was no improvement in long-term viral suppression and care retention in the rapid group during follow-up. Patients were more likely to initiate rapid ART after 2017 and were less likely if they required an interpreter. Conclusions Patients who received rapid ART had an improved cumulative HIV burden but no long-term improvement in care retention and viral suppression. Our findings suggest that rapid ART should be offered but additional interventions may be needed for patients newly diagnosed with HIV. [ABSTRACT FROM AUTHOR]

Aim: The current study aimed to identify and understand the reasons why allied health professionals think certain areas of healthcare service provision are a high priority for implementation of evidence into practice. Methods: A cross-sectional online survey using open-ended questions was conducted between April and May 2018 to identify potential areas for practice change and characterizehowparticipants justified identified areas of priority. Eligible participants were invited by email and included allied health professionals from public or private health services, governance agencies and universities across Australia. Responses were analysed using qualitative content analysis. Results: Therewere 149 surveys commenced with 146 respondents completing the survey. Of the 146 respondents, 128 were female, 17 male and one unknown. Most of the respondents were between 40 and 49 years old and had a master's degree. In total respondents from more than 13 different professions completed the survey with 110 respondents having more than 10 years of experience in allied health. Ten themes emerged outlining the main reasons respondents felt that their nominated areas of practice changewere a high priority for action. These included closing gaps between practice and policy/recommendation/guideline; closing research evidence to practice gaps; improving access to services; perceived cost-effectiveness of service delivery; improving effectiveness of allied health services; current imbalance between service supply and demand; amount of resources involved in service delivery; extent of the health problem; areas of allied health care futility; and equality of workload across allied health professionals. Conclusion: The current research provides insights into the decision-making processes of allied health professionals when prioritizing areas of clinical practice for implementation of evidence into practice. Despite an appetite for evidence-based practice, behaviour change was not always implemented in a consistent and systematic manner. There was variability in the type and application of evidence used by allied health professionals to support clinical practice. Whether a more systematic approach to research translation fosters evidence uptake awaits confirmation. Also awaiting investigation are the economic and societal impacts of consistently implementing research-informed clinical decision-making. [ABSTRACT FROM AUTHOR]

Background: It is widely acknowledged that health policy and practice do not always reflect current research evidence. Whether knowledge transfer from research to practice is more successful when specific implementation approaches are used remains unclear. A model to assist engagement of allied health managers and clinicians with research implementation could involve disseminating evidence-based policy recommendations, along with the use of knowledge brokers. We developed such a model to aid decision-making for the provision of weekend allied health services. This protocol outlines the design and methods for a multi-centre cluster randomised controlled trial to evaluate the success of research implementation strategies to promote evidence-informed weekend allied health resource allocation decisions, especially in hospital managers.Methods: This multi-centre study will be a three-group parallel cluster randomised controlled trial. Allied health managers from Australian and New Zealand hospitals will be randomised to receive either (1) an evidence-based policy recommendation document to guide weekend allied health resource allocation decisions, (2) the same policy recommendation document with support from a knowledge broker to help implement weekend allied health policy recommendations, or (3) a usual practice control group. The primary outcome will be alignment of weekend allied health service provision with policy recommendations. This will be measured by the number of allied health service events (occasions of service) occurring on weekends as a proportion of total allied health service events for the relevant hospital wards at baseline and 12-month follow-up.Discussion: Evidence-based policy recommendation documents communicate key research findings in an accessible format. This comparatively low-cost research implementation strategy could be combined with using a knowledge broker to work collaboratively with decision-makers to promote knowledge transfer. The results will assist managers to make decisions on resource allocation, based on evidence. More generally, the findings will inform the development of an allied health model for translating research into practice.Trial Registration: This trial is registered with the Australian New Zealand Clinical Trials Registry (ANZCTR) ( ACTRN12618000029291 ). Universal Trial Number (UTN): U1111-1205-2621. [ABSTRACT FROM AUTHOR]