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Challenges to the legitimacy of mental capacity over the past 10 years have been spearheaded by the Committee on the Rights of Persons with Disabilities, the treaty body for the UN Convention on the Rights of Persons with Disabilities (CRPD). This challenge has been asserted to have produced a ‘paradigm shift’. In this article, we examine why that interpretation has had such limited traction in the legal policy arena, and whether it should have traction. We also analyse whether the Committee has subtly but importantly shifted its position. We then develop an argument that the true goal, compatible with the CRPD, is the satisfactory determination of whether a person has or lacks mental capacity to make or take a relevant decision. Our article contextualises multi-disciplinary, research-informed guidelines designed as a contribution to satisfactory determination. While our article is based upon the position in England and Wales, we suggest that our conclusions are of wider application.

Ronit Stahl and Ezekiel Emanuel have recently issued a stark challenge to conscience protections in medical law and ethics. Their argument is flawed, however. They misrepresent the nature and relevance of conscientious protection in the military, misinterpret the scope of consent tendered by modern medical professionals, and offer no reason to think either that conscientious objection harms patient well-being or that such harm should solely determine the permissibility of conscientious objection. Moreover, and most fundamentally, Stahl and Emanuel do not recognize that conscience protections promote moral integrity, a basic aspect of human well-being that justifies protective action.

A mathematical model for the formation of condensation aerosols from highly supersaturated vapor-air mixtures is presented. The model is suitable for systems with very high nucleation rates that re...

Infrastructure resilience for a scenario can be assessed quantitatively from resilience curves that plot the evolution of system performance. Summary metrics map these curves to a single value to facilitate comparisons of different systems, scenarios, and policies. Commonly, these metrics are integral-based, e.g., cumulative infrastructure performance. However, since these curves and metrics only examine infrastructure performance, they fail to consider the dynamics of when stakeholders value the performance. For example, a power failure at a hospital during an ordinary day would be of less concern to emergency managers than during a hurricane recovery. This manuscript defines value weighting functions to represent the evolution of stakeholders’ value of performance. Temporal correlation between the performance and value weighting functions is described through a stochastic offset. Together, these concepts are used to define a holistic resilience metric: percent value satisfied. Through analytical and numerical approaches, percent value satisfied is treated as a resilience assessment’s stochastic output, and its distribution is compared to the naïve metric, cumulative infrastructure performance. The naïve summary metric is shown to be misleading in multiple potential scenarios; this work establishes that resilience assessments must consider the impact of time-varying stakeholder value and its correlation with infrastructure performance. These elements also provide new considerations for resilience assessments: opportunities to improve holistic system resilience without directly affecting infrastructure performance; hazard categories to inform value-weighted resilience analysis; and general insights to guide extensions from performance-based to value-weighted assessment.

Differences in building operator strategies can significantly affect building energy use and occupant comfort. However, it seems that the daily work of building operators and facility managers is still largely based on heuristics and individual experiences. In this work, we have investigated the current data collection methods during the operation and its daily use in buildings as well as the handling of occupant behavior, comfort, and user complaints based on interviews with ten building operators in Germany. These interviews were conducted as part of an international study of building operator OCC (Occupant-Centric Control) strategies, under the auspices of the IEA EBC Annex 79. The results of the interviews clearly reflect, that until now, communication between building operators and building occupants plays a more important role in optimizing or adjusting building operations to meet occupant needs than the data collected by BAS, which is mainly used to detect faults and check the system status of key HVAC components when faults occur. In some cases, the real-time data are applied for the adjustment of set points and schedules depending on measured conditions; however, customization of set points considering the user’s preferred temperature or ventilation rate or building operation based on occupancy detection has not yet been implemented in the considered buildings. The overall objective of this contribution to building operation research is to highlight best practices and identify white spaces that fulfill occupant requirements and achieve a high level of energy-efficiency. The presented findings identify current gaps between science and practice in the field of sustainable optimization of building operation, but also point out real-world starting points for future research and development.

Measuring the aerosol particle size of electronic cigarettes can be particularly challenging due to the volatile and dynamic nature of these aerosols. In particular, electronic cigarette aerosol pa...

Introduction : Chaque année l'OMS dénombre près d'un million de nouveaux cas de méningites bactériennes avec une létalité de 10%. Depuis l'introduction du vaccin contre l'Haemophilus influenzae b (Hib) en 2005, du vaccin contre le Streptococcus pneumoniæ en 2011 et les campagnes de vaccinations de masse contre le Neisseriameningitidis A, aucune étude n'a porté sur les méningites bactériennes dans le service de pédiatrie de l'hôpital du Mali d'où l'initiation de ce travail.Matériels et méthodes : Il s'agissait d'une étude descriptive rétrospective couvrant la période de 01Janvier 2012 au 31 Décembre 2017 et prospective allant du 01 Janvier au 31 Décembre 2018 chez les enfants d'un mois à 15 ans hospitalisés pour méningite bactérienne dans le service de pédiatrie de l'Hôpital du Mali.Résultats : Durant la période de notre étude nous sur les 6429 enfants hospitalisés nous avons enregistré 88 cas de méningites bactériennes soit, une fréquence hospitalière de 1,4%. Le sex ratio était de 1,5. Les enfants de moins de 5 ans étaient les plus touchés (71,6%). Les enfants étaient immunisés contre Hib (72,7%) et pneumocoque (71,6%) . La fièvre était présente chez 80,6% de nos enfants associées ou non au coma (68.2%%, à la convulsion (56,8%) et à l'agitation (13,6%). Les principaux germes isolés étaient : le Streptococcus pneumoniæ (36,4 %), le NeisseriameningitidisW135, X, C (12,5%) et l'Haemophilus influenzae (9,1%). L'association du Ceftriaxone et de la gentamycine a été utilisée avec succès chez 77.3% de nos enfants. Le taux de guérison était de 64,8%, le taux des séquelles (12, 5%) et le taux de létalité (18, 2%).Conclusion : Le pneumocoqueest le germe majoritairement responsable des méningites bactériennes malgré l'introduction du vaccin antipneumococcique conjugué treize valent. Les sérogroupes W135, X, et C de méningocoque qui sont aussiresponsables des méningites dans notre service

Introduction : le tétanos néonatal constitue une cause importante de morbidité et de mortalité néonatales dans les pays en développement. Méthodologie : il s’agissait de 3 cas de tétanos néonatal hospitalisés de janvier 2017 à juillet 2018 à la néonatologie de l’hôpital du Mali. Résultats : les nouveau-nés ont été reçus pour trismus. Ils étaient nés à terme par voie basse après une grossesse mal suivie. Leurs mamans n’étaient pas vaccinées contre le tétanos. Dès la première semaine de vie, ils ont présenté une fièvre et un trismus. Sous traitement, le premier est guéri au bout de 15 jours. Les deux autres sont décédés dès les premiers jours de leur hospitalisation dans un tableau d’hypertonie fébrile. Conclusion : le tétanos néonatal est une maladie grave évitable par la vaccination qui sévit encore dans les pays en développement.

Due to the uncontrollable generators, islanded microgrids powered only by renewable energy require costly energy storage systems. Energy storage needs are amplified when load and generation are misaligned on hourly, monthly, or seasonal timescales. Diversification of both loads and generation can smooth out such mismatches. However, the ideal type of battery to smooth out remaining generation deficits will depend on the duration(s) that energy is stored. This study presents a controls co-design approach to design an islanded microgrid, showing the benefit of hybridizing tidal and solar generation and hybridizing lithium-ion and flow battery energy storage. The optimization of the microgrid’s levelized cost of energy is initially studied in grid-search slices to understand convexity and smoothness. Then, a particle swarm optimization is proposed and used to study the sensitivity of the hybrid system configuration to variations in component costs. The study highlights the benefits of controls co-design, the need to model premature battery failure, and the importance of using battery cost models that are applicable across orders of magnitude variations in energy storage durations. The results indicate that such a hybrid microgrid would currently produce energy at five times the cost of diesel generation, but flow battery innovations could bring this closer to only twice the cost while using 100% renewable energy.

La cryptococcose neuroméningée (CNM) est une mycose cosmopolite grave, affectant généralement les sujets ayant un déficit de l’immunité cellulaire surtout les séropositifs au virus de l'immunodéficience humaine (VIH).Nous rapportons l’observation d’un cas chez une fille de 7 ans, admise pour altération de l’état général, trouble de la conscience (Glasgow à 8/15), syndrome méningé (raideur de la nuque, signe de Kernig et de Brudzinski) et tétraplégie prédominant à gauche. La tomodensitométrie (TDM) cérébrale avait mis en évidence une dilatation de l’ensemble des cavités ventriculaires avec hypodensité périventriculaire cérébrale.La ponction lombaire (PL) avait ramené un liquide cérébrospinal (LCS) clair. L’analyse du LCS avait permis de retrouver une méningite pléiocytaire, hyperprotéinorachique, hypoglycorachique et un Cryptococcusneoformans. Un traitement antifungique associant amphotéricine B et fluconazole avait été instauré.La patiente avait aussi subit un drainage chirurgical de l’hydrocéphalie. Après 12 semaines d’hospitalisation, le décès était survenu dans un contexte d’altération de l’état général, de convulsions à répétition et de coma profond. La cryptococcose neuroméningée pose un sérieux problème de diagnostic et de traitement chez l’enfant immunocompétent à cause de l’insuffisance des moyens d’investigation et de traitement.

This study investigates the association between neighborhood disadvantage from adolescence to young adulthood and metabolic syndrome using a life course epidemiology framework. Data from the United States-based National Longitudinal Study of Adolescent to Adult Health (n = 9500) and a structural equation modeling approach were used to test neighborhood disadvantage across adolescence, emerging adulthood, and young adulthood in relation to metabolic syndrome. Adolescent neighborhood disadvantage was directly associated with metabolic syndrome in young adulthood. Evidence supporting an indirect association between adolescent neighborhood disadvantage and adult metabolic syndrome was not supported. Efforts to improve cardiometabolic health may benefit from strategies earlier in life.

Effective real-time execution of nonlinear model predictive control (NMPC) on embedded systems is significantly dependent on the controller formulation. This paper studies the effect of model structure and cost functions on the computation time of scalar bilinear NMPC using variational methods, with hydronic cooling applications. Two algebraically equivalent nonlinear model structures common in literature are primarily considered: a linear state equation with state-dependent control constraints and a bilinear state equation with time-invariant rectangular control constraints. Additionally, the effects of three cost function formulations are also considered: minimum-time, quadratic regulation, and efficient state constraints. High-fidelity computer simulations, hardware-in-the-loop testing, and experiments on a bench-scale hydronic cooling system are used to study sources of computational complexity, rates of convergence, initialization techniques, and overall effectiveness of the different models and costs. These results suggest that NMPC with bilinear state equations, minimizing pump power and a one-sided quadratic state cost, converges sufficiently fast and reliably. This presents an attractive alternative to the traditionally constrained linear quadratic regulator-based NMPC on embedded systems.

The development and production of engineered 2D nanomaterials are expanding exponentially, increasing the risk of their release into the aquatic environment. A recent study showed 2D MnO2 nanosheets, under development for energy and biomedical applications, dissolve upon interaction with biological reducing agents, resulting in depletion of intracellular glutathione levels within fish gill cells. However, little is known concerning their toxicity and interactions with subcellular organelles. To address this gap, we examined cellular uptake, cytotoxicity and mitochondrial effects of 2D MnO2 nanosheets using an in vitro fish gill cell line to represent a target tissue of rainbow trout, a freshwater indicator species. The data demonstrate cellular uptake of MnO2 nanosheets into lysosomes and potential mechanisms of dissolution within the lysosomal compartment. MnO2 nanosheets induced severe mitochondrial dysfunction at sub-cytotoxic doses. Quantitative, single cell fluorescent imaging revealed mitochondrial fission and impaired mitochondrial membrane potential following MnO2 nanosheet exposure. Seahorse analyses for cellular respiration revealed that MnO2 nanosheets inhibited basal respiration, maximal respiration and the spare respiratory capacity of gill cells, indicating mitochondrial dysfunction and reduced cellular respiratory activity. MnO2 nanosheet exposure also inhibited ATP production, further supporting the suppression of mitochondrial function and cellular respiration. Together, these observations indicate that 2D MnO2 nanosheets impair the ability of gill cells to respond to energy demands or prolonged stress. Finally, our data demonstrate significant differences in the toxicity of the 2D MnO2 nanosheets and their microparticle counterparts. This exemplifies the importance of considering the unique physical characteristics of 2D nanomaterials when conducting safety assessments.

Entomophagy is being explored as a sustainable food source in Western countries to combat the ever-increasing effects of climate change. Studies conducted in various European countries determine the factors affecting willingness to consume insects. The current study aims to gain the first insight on this topic in Ireland, a country with a long farming tradition. A survey including open- and closed-ended questions was developed and sent to students and staff of an institute of technology in the West of Ireland. The willingness to consume insects and the factors affecting willingness to consume them under different conditions were assessed. It was found that less neophobic males who do not follow a particular diet were most receptive to entomophagy. People who were willing to try insects were less willing if the insects were to be eaten whole. People who were not willing were more inclined to do so if they were disguised or used to feed livestock. Food neophobia, disgust and safety concerns were barriers to acceptance. Tasty products containing disguised insects in familiar foods are the most likely to be accepted. Education and taste tests are recommended first steps to introducing entomophagy. Using insects to feed livestock has the potential to improve acceptance of entomophagy by introducing insects in the supply chain. However, further research should be conducted to assess acceptance of this amongst Irish farmers. The current study agrees with findings of studies conducted in other European countries and reveals the conditions under which insects could become acceptable among Irish consumers.

Resilience curves are used to communicate quantitative and qualitative aspects of system behavior and resilience to stakeholders of critical infrastructure. Generally, these curves illustrate the evolution of system performance before, during, and after a disruption. As simple as these curves may appear, the literature contains underexplored nuance when defining "performance" and comparing curves with summary metrics. Through a critical review of 273 publications, this manuscript aims to define a common vocabulary for practitioners and researchers that will improve the use of resilience curves as a tool for assessing and designing resilient infrastructure. This vocabulary includes a taxonomy of resilience curve performance measures as well as a taxonomy of summary metrics. In addition, this review synthesizes a framework for examining assumptions of resilience analysis that are often implicit or unexamined in the practice and literature. From this vocabulary and framework comes recommendations including broader adoption of productivity measures; additional research on endogenous performance targets and thresholds; deliberate consideration of curve milestones when defining summary metrics; and cautionary fundamental flaws that may arise when condensing an ensemble of resilience curves into an "expected" trajectory., Comment: 32 pages, 4 figures. Submitted to Reliability Engineering & System Safety

BackgroundThere are currently ten biologic and targeted synthetic (b/ts)DMARDs acting via five different modes of action (MOA) available for the treatment of psoriatic arthritis (PsA) in Australia. b/tsDMARDs are government-subsidised, and once the patient reaches the eligibility requirements, the clinician can prescribe the agent deemed most appropriate. Available agents include TNF inhibitors (TNFi, adalimumab, etanercept, infliximab, golimumab, certolizumab pegol), IL-17A inhibitors (IL-17Ai, secukinumab, ixekizumab), and IL-12/23 inhibitor (IL-12/23i, ustekinumab). Two new MOAs were recently added to the rheumatologist’s armamentarium: the first JAK inhibitor (JAKi, tofacitinib) was subsidized from May 2019 followed by upadacitinib from Oct 2021, and an IL-23 inhibitor (IL-23i, guselkumab) was subsidized from July 2021.ObjectivesThe aim of this analysis was to describe the changing patterns of b/tsDMARD use for the treatment of PsA in real-world practice in Australia.MethodsDeidentified clinical data were sourced from the OPAL dataset, which is collected in a custom-built electronic medical record during the routine consultation1. Data from patients >18 years with a physician diagnosis of PsA who were prescribed a b/tsDMARD between Jan-2007 and Sept-2021 were included in the analysis. The software program Tableau was used to display the data.ResultsAt Sept 2021, 6,150 (38% of the total) patients with PsA in the OPAL dataset were prescribed b/tsDMARDs. Of these patients, 3741 (61%) were currently prescribed a TNFi, 1503 (24%) an IL-17Ai, 556 (9%) a JAKi, 222 (4%) an IL-12/23i and 134 patients (2%) an IL-23i. Over time, the 1st line TNFi initiations have decreased from 79.5% in 2018 to 65.2% in 2021. Conversely, 1st line IL-17Ai initiations have increased from 14.4% in 2018 to 22.2% in 2021. In 2021, TNFi accounted for 53.4% of 2nd line initiations and 38.2% of 3rd line initiations. IL-17Ai accounted for 30.4% of 2nd and 37.0% of 3rd line initiations and JAKi accounted for 10.5% of 2nd line and 14.2% of 3rd line initiations. In the 3 months that IL-23i has been subsidised, this MOA was the most initiated agent for patients who had been treated with more than two prior b/tsDMARDs. In 2021, 52.1% of patients switching from a 1st line TNFi switched to an alternative TNFi, 33.3% switched to an IL-17Ai and 11.3% switched to a JAKi in 2nd line. Of those switching from a 1st line IL-17Ai, 59.6% initiated a TNFi, 21.2% switched to an alternative IL-17Ai and 11.5% switched to a JAKi.ConclusionThe patterns of b/tsDMARD utilisation for the treatment of PsA, when the choice of agent is at the discretion of the rheumatologist, remains dynamic and is evolving as new MOAs become available. TNFi remains the most prescribed b/tsDMARD for first line therapy. However an increase in first line use of alternative MOAs has been observed. TNFi cycling remains a commonly utilised real world treatment strategy but appears to be declining as new MOAs become available.References[1]Littlejohn GO, Tymms KE, Smith T, Griffiths HT. Using big data from real-world Australian rheumatology encounters to enhance clinical care and research. Clin Exp Rheumatol. Sep-Oct 2020;38(5):874-880.Figure 1.Percentage of patients initiating b/tsDMARDs by year and line of therapy.AcknowledgementsThe authors acknowledge the members of OPAL Rheumatology Ltd and their patients for providing clinical data for this study, and Software4Specialists Pty Ltd for providing the Audit4 platform.Disclosure of InterestsPeter Youssef Speakers bureau: AbbVie, Novartis, Eli Lilly, Sabina Ciciriello: None declared, Gene-Siew Ngian: None declared, Juan Aw: None declared, Barry Kane: None declared, Catherine OSullivan: None declared, Tegan Smith: None declared, Claire Deakin: None declared, Geoff Littlejohn Consultant of: Abbvie, Janssen, Bristol Myers Squibb, Gilead, Eli Lilly, and MSD