Radical climate protests have been theorized to shape perceptions of moderate climate groups, a dynamic known as the radical flank effect (RFE). We examine this phenomenon through a longitudinal analysis of German media discourse on climate protests. Using validated large language model prompts, we annotated stances and anger in 2376 news articles and 225,121 user comments covering the moderate activist group Fridays for Future (FFF) and the more radical Last Generation (LG). Short-term increases in LG protest coverage were associated with increased support for FFF in news articles and left-leaning outlets' user comments, but with decreased support in right-leaning comments. However, these patterns were not observed over longer time periods. Although anger expressed in the general coverage of climate protests impacted subsequent support for FFF, this effect was not specific to coverage of radical protests. These findings highlight the temporally bounded and ideologically contingent nature of RFEs in media discourse.
The COVID-19 pandemic unfolded alongside an unprecedented 'infodemic' that reshaped public engagement with science, health, and authority. This study examines how online infodemics translated into collective resistance and influenced population health through political mobilisation. Using structural equation models across six European countries, I conceptualise resistance as a latent construct - captured by residential mobility and protests opposing vaccines, lockdowns, and public health measures linked to populist radical right (PRR) movements - acting as a behavioural bridge between digital information environments and epidemic outcomes. The findings reveal a robust infodemic-resistance-epidemic pathway: greater exposure to infodemic content consistently predicts stronger opposition to non-pharmaceutical interventions (NPIs) and vaccination. This effect is strongest in Germany and Italy, where PRR networks amplified narratives of 'elite overreach' and 'freedom under threat', transforming online discontent into organised mobilisation. In other countries, resistance appears weaker and more pandemic-specific. By integrating informational, political, and epidemiological processes, the analysis shows how epidemics can evolve into politicised collective behaviour that undermines compliance and sustains transmission. The results highlight populist mobilisation as a key amplifier of epidemic risk and suggest that effective responses must rebuild trust, depoliticise health communication, and address structural sources of grievance.
Protests are a persistent feature of contemporary urban life, often producing mass injuries through police repression. Yet the role of medical care in these contexts-especially when provided by informal collectives-remains understudied. Drawing on 21 in-depth interviews with members of volunteer medical brigades during Chile's 2019-2020 Estallido Social, this paper examines how care was improvised, coordinated and transformed under conditions of sustained police violence, where more than 3500 people were wounded and 36 died. The analysis explores how brigade members interpreted harm, navigated the collapse of medical neutrality, which was first denied by the state and then renounced by brigade members, and embedded rudimentary clinical practice within the protest itself. The paper proposes the concept of protest medicine. Unlike security-based approaches that presuppose the legitimacy of state action, protest medicine is a grassroots, politically entangled form of medical care shaped by the spatial, ethical and affective logics of protest. In doing medicine outside and against the state, protest medicine foregrounds a form of healthcare rooted in proximity, solidarity and resistance rather than neutrality, regulation and order, opening space to rethink the social and political functions of medicine when the state is a source of harm.
暂无摘要（点击查看详情）
In 2022, the case of Andrea Prudente, an American tourist denied an abortion for a non-viable pregnancy in Malta, catalysed unprecedented social mobilisation, and compelled a legislative review of the country's abortion ban. This paper traces the political and social dynamics that shaped this process, from the initial advocacy to the final, heavily contested legislative outcome. Drawing on Morgan and Roberts' concept of reproductive governance, we examine media content and parliamentary discourses to trace how state actors mediated the conflict between competing moral, and legal frameworks. Our analysis demonstrates that while persistent pressure by pro-choice advocates was instrumental in forcing a legislative review, the government's initial proposed reforms were systematically contested, and ultimately neutralised by a powerful, well-organised anti-choice countermovement. We argue that state actors ultimately capitulated to immense conservative pressures from influential religious and civil society actors. The resulting amendment, which permits termination only under exceptionally restrictive circumstances to save a pregnant person's life, is a stark example of how reproductive governance can accommodate pressure for change while leaving the underlying system intact. This process highlights how legal reform can be critically decoupled from meaningful access, failing to secure genuine reproductive rights. Despite its profound limitations, the amendment constitutes the first-ever legal exception to Malta's absolute ban, proving that such entrenched governance frameworks are not immutable. The Prudente case and the mobilisation it inspired have irrevocably fractured the previous politico-legal consensus, thereby creating a precedent for future legal challenges and continued advocacy for comprehensive reproductive justice in Malta. In 2022, an American tourist in Malta named Andrea Prudente needed an abortion for a pregnancy that could not survive. Doctors refused because of the country's total ban. Her case sparked major protests and forced the Maltese government to review its abortion law. This paper studies how this process unfolded. We looked at newspapers and political speeches. We wanted to understand the arguments of those fighting for abortion rights and those against them. We found that those fighting for abortion pushed the government to act. But a powerful and well-organised anti-choice movement fought against any changes. The government gave in to pressure from influential conservative and religious groups. The result was a new law that is very restrictive. It only allows an abortion in rare cases to save the pregnant person's life. This change does not provide meaningful access to abortion care. Yet, this is the first time there was a change to Malta's complete ban. This shows that the old rules can change. It creates an important starting point for future work to secure full reproductive rights in Malta.
The structural neuroanatomy underlying Major Depressive Disorder (MDD) remains elusive and even large-scale neuroimaging studies and meta-analyses produced inconsistent outcomes with marginal effect sizes. Furthermore, the replicability of brain-psychopathology associations is under scrutiny, attributable to inadequately powered sample sizes and inflated effect sizes. The present study aimed to examine the effect sizes, replicability, and generalizability of brain structural alterations in MDD, harnessing the wealth of three large-scale clinical cohorts. We used three independent cohorts totaling n = 4021 deeply characterized participants (aged 15-65 years), encompassing MDD patients (n = 1764), and healthy controls (HC; n = 2257) with individual MRI data. The diagnosis was confirmed by structured clinical interviews. Brain-wide case-control differences in voxel-based morphometry were tested. We conducted pooled analyses to maximize statistical power, and further investigated cross-cohort replicability and generalizability by inspecting 1) correlations between t-maps from each cohort, 2) converging significance across the three cohorts, and 3) by using a cross-validation framework, iterating through cohorts as independent test sets. Pooling all individuals together yielded reduced gray matter volumes in patients with MDD in widespread bilateral clusters, covering the insula, thalamus, orbitofrontal cortex, and a parahippocampal-fusiform-lingual complex. No evidence was found for differences within the hippocampus. The largest effect size was found in the bilateral anterior insula (partial R2 = 0.01). Analyzing cohorts separately yielded 1) t-map correlations between cohorts (r = 0.212 to r = 0.281), 2) replicability indicated by overlapping significance in multiple areas exceeding thresholds in each single cohort, and 3) generalizability of case-control differences in clusters that were deemed non-significant in single cohorts, implicating further frontal, temporal and cerebellar regions. Results indicate that gray matter correlates of MDD are subtle but nevertheless replicable and generalizable. These alterations are localized in an array of regions involved in emotion regulation and sensory processing. Our investigation underscores the need to investigate the replicability and generalizability of mental health neuroimaging findings and provides a tangible framework for this endeavor.
There is a growing public support for medical interventions at the End of Life (EoL), such as euthanasia and physician assisted suicide (EPAS) and palliative sedation (PS). This paper explores pastors' views and their pastoral care on the place of EPAS and PS and uses a 2.556 pastors' survey. Whereas only 38% were in favour of EPAS, more than 90% could justify PS. This paper analyses the differences in pastors' attitudes regarding EPAS versus PS.
Human papillomavirus vaccine acceptance is influenced by the parental perceptions of the vaccine, but there are few related studies in Ethiopia, and most have focused on quantitative approaches. Therefore, this qualitative study intended to explore parental perceptions about the human papillomavirus vaccine acceptance. To explore the perceived facilitators and barriers against human papillomavirus among rural parents with eligible daughters in the Alle district, southern Ethiopia. A qualitative study using focus group discussion and in-depth interviews was conducted from April 25, 2023, to May 25, 2023, among eligible parents of daughters in the Alle district, southern Ethiopia. A convenience sample of 53 parents was recruited for focus group discussions, and 15 parents were purposely sampled for in-depth interviews. The data were collected by a semi-structured focus group discussion guide and in-depth interview questionnaires. The interview data were translated into English after transcription, and thematic analysis was done by Atlas software version 7.1.16. Among the total participants, 66.2% were female parents and 60.2% were protestant religious followers. Findings were split between two major themes: perceived facilitators and barriers to human papillomavirus vaccine acceptance. The perceived facilitators identified were preventing cervical cancer, seeing it as an expression of parental role and responsibility, and believing in the recommendation of health professionals as facilitators of human papillomavirus vaccination. The identified perceived barriers to human papillomavirus vaccination included: a lack of awareness, a lack of reliable information sources, a lack of trust in the vaccine, misconceptions, fear of side effects, and cultural and religious factors affecting the acceptance of human papillomavirus vaccination. Parents identified various facilitators and barriers to accepting the human papillomavirus vaccine. Therefore, we recommend that the government and concerned institutions work in collaboration to address the identified challenges to improve the acceptance of human papillomavirus vaccination.
A growing body of research highlights the fear extinction model as a key framework for understanding the pathology of anxiety disorders and developing therapeutic interventions. Functional imaging studies link successful extinction recall and reduced amygdala reactivity with ventromedial prefrontal cortex (vmPFC) activity, while dysfunctional vmPFC activity is associated with anxiety pathology. Enhancing vmPFC activity through transcranial direct current stimulation (tDCS) has thus emerged as a promising approach to augment cognitive behavioral therapy (CBT) and therapeutic exposure therapies for anxiety disorders. In this study, anodal tDCS was applied over the vmPFC during the extinction learning phase of a 3-day fear acquisition/extinction paradigm (anodal tDCS: 21, sham tDCS: 23 participants). Skin conductance response (SCR) and Blood Oxygenation Level Dependent (BOLD) brain activity were recorded simultaneously. Healthy participants who received real tDCS showed significantly improved extinction recall compared to the sham tDCS group, as indicated by the SCR. Fear acquisition activated core regions of the fear network, including the anterior cingulate cortex, amygdala, orbitofrontal cortex, and insular cortex. During extinction learning, real tDCS activated both fear and safety networks (particularly the posterior cingulate and middle temporal cortex) during early extinction, while the sham tDCS group showed activity only in the fear network. Furthermore, a decoupling of the vmPFC with fear network regions with real tDCS during extinction was observed, indicating strengthened inhibitory control. These findings suggest that anodal tDCS over the vmPFC promotes early activation of the safety network, enhancing extinction learning and consolidation. This suggests its translational potential as an adjunctive intervention for anxiety disorders.
The Kivu-Rusizi basin, a transboundary biodiversity hotspot in East Africa and home to eight key biodiversity areas (KBAs), possesses resources essential for local and global communities, including critical minerals. However, it confronts various conservation challenges, primarily stemming from increasing socio-economic demands, security instability, a lack of joint monitoring, and insufficient comprehensive research across the basin among the involved countries. This study delivers the first assessment and projections of spatial habitat quality in the basin and its KBAs from 2017 to 2031 by integrating the InVEST habitat assessment model with land-use change predictions from the MOLUSCE-QGIS model to understand habitat quality status, the impacts of land-use dynamics, vulnerability hotspots, drivers of change, and needs to be addressed in the basin's conservation. The results reveal widespread habitat vulnerability, particularly impacting rangelands, which are projected to decline by 9.4 percentage points. Basin-wide habitat quality is expected to decrease from 93.5 to 88%, with KBAs experiencing a decline from 95.1 to 90.1%. Specific KBAs, such as Virunga, Kibira, Rusizi, and Itombwe National Parks, show substantial declines, with 35 to 50% of their habitats in vulnerable conditions. Other KBAs, including Nyungwe, Kahuzi-Biega, and Gishwati-Mukura National Parks, are expected to face additional threats, particularly from roads and built-up infrastructure. Threat extent and intensity analysis revealed complementary threats with diverse impacts: deforestation, mining, and agriculture dominated by spatial coverage (78.5% of total impact; deforestation alone >40%), while mining and urbanization showed the strongest per-unit impact (β = -8.20 and -5.48; p < 0.001), with odds ratios near zero (OR = 0.0003 and 0.004), indicating that the presence of these drivers almost entirely eliminates the probability of suitable habitat quality at their operational sites. The study highlights the urgent need for continuous border monitoring, habitat conservation, and cross-border policy harmonization among the three countries within the basin.
Gamma oscillations are critical for cognitive functions. While phase-synchronized electric and magnetic stimulation can boost oscillatory brain activities in theta, alpha, and delta bands, the effects on gamma frequencies have not been investigated yet, especially with respect to functional connectivity and cognitive effects. This study explores how novel non-invasive techniques, phase-locked 40Hz intermittent theta-burst stimulation (iTBS) and 40Hz transcranial alternating current stimulation (tACS), affect working memory performance and associated functional connectivity parameters. Thirty healthy young participants completed five stimulation conditions (1) 40Hz tACS + sham iTBS, (2) 40Hz iTBS + sham tACS, (3-4) two combined interventions (iTBS pulses phase-locked to the tACS peak sine (X-tACS peak) wave or tACS trough sine wave (X-tACS trough), and (5) sham iTBS + sham tACS condition in separate working-memory and resting-EEG sessions, resulting in 10 sessions in total. The target regions were the left and right dorsolateral prefrontal cortices and were stimulated by simultaneous 40Hz tACS and iTBS for 20 min. Working memory performance and functional brain connectivity metrics for local synchronization and global network efficiency were monitored before and after each intervention. Only the 40Hz tACS + sham iTBS and 40Hz iTBS + sham tACS protocols enhanced high-load working memory performance speed. The same protocols, along with the X-tACS peak protocol, more pronouncedly improved functional connectivity metrics during the 30 min post-intervention compared to sham, corresponding to the behavioral testing period in separate sessions. These results suggest a temporal relation between alterations of functional brain connectivity and working memory task performance.
Sex workers worldwide experience different forms of violence and stigma that increase the risk of adverse health outcomes. It is assumed that a discriminatory, criminalizing context as well as intersectional stigma increases the risk of sexual violence for sex workers. We aim to answer the following questions: (1) What types of sexual violence do sex workers experience and (2) how frequently do they encounter it? (3) To what extent are these types of sexual violence associated with mental and sexual health conditions? (4) Are these associations moderated by legislative models? In a preregistered systematic review (PROSPERO: CRD42024503922), scientific databases, references from meta-analyses, and publications from sex work organizations were searched. A total k = 207 quantitative and qualitative studies (N = 157,991) published since 2013 were summarized meta-analytically and narratively. Sex workers experience sexual violence across various contexts, with quantitative records identifying rape as the most prevalent form. Qualitative findings document varied forms of sexual violence including non-penetrative acts, sexual harassment, technology-facilitated sexual violence, and sexual neglect. The lifetime prevalence of sexual violence is 26.3% (95% Confidence Interval [CI] 22.0-31.0). Mental health conditions (depressive, post-traumatic stress symptoms, and suicidality) were associated with sexual violence: OR [95% CI] = 1.85 [1.58-2.16], p < .001, as were alcohol and other recreational drugs: OR [95% CI] = 1.95 [1.59-2.38], p < .001. Both sexually transmitted infections, including HIV (OR [95% CI] = 1.36 [1.11-1.66], p = .003) and reproductive health related outcomes (OR [95% CI] = 1.76 [1.18-2.63], p = .013) were significantly associated with sexual violence. Potential moderation by legislative model could not be detected due to insufficient data. This systematic review suggests sexual violence against sex workers as a critical human rights issue. However, the generalisability of these findings is constrained by substantial statistical heterogeneity and limited representativeness within the current literature, which remains focused predominantly on cisgender women in in-person sex work. This calls for redefining sexual violence with input by sex workers and addressing structural inequities to aid in destigmatizing sex work and reducing social inequities.
Action observation and execution, transcranial direct current stimulation (tDCS) and peripheral nerve stimulation (PNS) enhance motor performance. This study aimed to investigate the effect of concurrent tDCS over the premotor cortex (PMC) and PNS during action observation on motor cortex excitability and motor performance, and its underlying mechanisms. One hundred and twenty-eight healthy adults were randomly assigned to tDCS + PNS combined with presentation of a landscape picture (tDCS + PNSlandscape), and tDCS + PNS, tDCSsham+ PNSsham, tDCSsham + PNS and tDCS + PNSsham combined with action observation, all followed by two action execution blocks. Motor-evoked potentials (MEPs), intracortical facilitation (ICF) and short-interval intracortical inhibition (SICI) were assessed before interventions (T0), immediately after interventions (T1) and after the first action execution block (T2). Reaction times were recorded for both action execution blocks (RT1 and RT2). tDCS + PNS significantly increased MEP amplitudes at T1 and T2 compared to tDCSsham + PNSsham and tDCS + PNSlandscape. ICF increased at T1 in the tDCS + PNS group compared to tDCSsham + PNSsham and tDCS + PNSlandscape, as well as at T2 relative to tDCSsham + PNSsham. RT1 and RT2 of the action execution task in the tDCS + PNS group were significantly shorter compared to the tDCSsham + PNSsham group. A significant negative relationship between the change in RT and MEP amplitudes emerged at T2 in the tDCS + PNS group. Concurrent application of tDCS and PNS during action observation induced transient neuroplastic alterations in the primary motor cortex and improved motor performance. KEY POINTS: The integration of motor observation and action execution enhances motor performance, with similar brain networks playing key roles in this process. However, the effect of concurrent application of transcranial direct current stimulation (tDCS) over the premotor cortex and peripheral nerve stimulation (PNS) during action observation on observation-execution-related motor cortex excitability and motor performance and the underlying mechanism is lacking in the literature. Simultaneous application of brain (anodal tDCS over the premotor cortex) and peripheral nerve (PNS over the ulnar nerve) stimulation during action observation induced transient neuroplastic alterations in the primary motor cortex and improved motor performance. Since this dual-stimulation method strengthens brain pathways related to movement, it could be especially useful for people recovering from conditions like stroke, where active movement is limited.
暂无摘要（点击查看详情）
Febrile infection-related epilepsy syndrome (FIRES) is a rare, severe epileptic encephalopathy characterized by refractory status epilepticus, primarily affecting previously healthy children aged 3-15 years. The pathogenesis remains unknown, and outcomes are predominantly poor. This study investigates the acute phase treatment of FIRES, focusing on antiseizure medications (ASMs) and deep sedation with therapeutic coma (TC) for the treatment of status epilepticus, to examine associations with long-term functional outcome. We retrospectively analyzed data from 93 children in a multicenter registry-based cohort from our FIRES registry, assessing acute phase ASMs and duration of TC. Neurological outcomes were assessed using the modified Rankin Scale (mRS), with correlation analyses, multivariate logistic regression, and Cox proportional hazard analyses to explore associations between treatment intensity, functional outcomes, and survival. Higher ASMs count was associated with worse outcome, with each additional medication for seizure control corresponding to 52% increased odds of mRS ≥4 (adjusted odds ratio 1.52, 95% confidence interval 1.17-2.10, P < 0.001). Longer duration of TC correlated with a more ASMs and higher mRS scores, indicating inferior outcome. In our analysis, increased acute treatment intensity and longer durations of TC were associated with worse functional outcomes. These observational associations are likely confounded by underlying disease severity. In the absence of proven causal therapies, the data might be compatible with spontaneous reduction of seizure activity over time in some patients and highlight the need for further research on pathogenesis and pathogenesis-targeted therapies for FIRES.
Though especially in the last decade, much work has been done on various aspects of palliative sedation, little attention has been given to the role played by religious beliefs and traditions. Since the attitudes and decisions of patients, family members, and caregivers can be deeply influenced by religion when faced with severe suffering at the end of life, it is important to know the views of these traditions regarding palliative sedation. This study discusses and compares normative views in Christian denominations (Anglicanism, Catholicism, Eastern Orthodoxy, Protestantism) and Indian religions (Hinduism, Buddhism, Sikhism). This study used a scoping study method to analyse religious normative perspectives on palliative sedation. Comprehensive database and grey literature searches were conducted to gather relevant sources from Christian denominations and Indian religions, followed by snowballing and expert consultation. The systematic mapping of views and arguments was followed by a grounded theory analysis of the mapped information and a comparative analysis between the Christian and Indian religious traditions. This manuscript is written following the Scoping Reviews PRISMA-ScR checklist. Christian traditions generally view palliative sedation as a morally acceptable means to relieve suffering, grounded in charity and dignity, but in doing so stress the importance of intent and a clear distinction from euthanasia. Concerns persist regarding the impact of lowered consciousness on the spiritual preparation for death, especially in Eastern Orthodox traditions; Protestant perspectives add the issue of autonomy and personal agency. Indian religions lack robust explicit authoritative statements but commonly value consciousness at the moment of death for spiritual reasons related to rebirth and karma. Palliative sedation could be an option, but Indian religious traditions also emphasize spiritual practices, such as prayer and meditation, to alleviate end-of-life suffering. Religious traditions significantly influence views and practices concerning palliative sedation, shaping both professional and patient decisions in advanced disease care. The major Christian denominations permit palliative sedation with safeguards, while Indian religions generally recommend spiritual awareness at life's end but accept palliative sedation as an option. Recognizing these beliefs deepens understanding of diverse end-of-life values and enhances culturally and religiously sensitive care in palliative settings.
Despite efforts to improve vaccination coverage, many children remain insufficiently protected in sub-Saharan Africa where health systems remain fragile. This study aimed to identify systemic barriers to achieving yellow fever vaccine coverage targets in the Democratic Republic of the Congo (DRC). An analytical cross-sectional survey was conducted from January to August 2024 in 156 health areas across six provinces of the DRC. The study population included 1247 children aged 9-23 months and their mothers or guardians. Data collected covered sociodemographic, socioeconomic, and contextual characteristics related to the organization of the health system. Logistic regression was used to identify factors associated with lack of vaccination coverage at a significance level of p < 0.05. Yellow fever vaccine (YFV) coverage was 80.8%. Multivariate analysis identified several barriers to YFV coverage: maternal occupation (aOR = 1.82), precarious housing (aOR = 3.14), the presence of at least two children in the household (aOR = 1.42), the rainy season (aOR = 5.92), absence of community awareness activities (aOR = 4.42), and reliance on a fixed vaccination strategy (aOR = 5.73). These findings highlight the importance of socioeconomic and organizational determinants in access to vaccination. Strengthening outreach strategies, community mobilization, and adapting services to environmental constraints appear essential to improve vaccination equity and achieve coverage targets in endemic settings.
Personality traits and depressive symptoms are closely related, yet their coordinated change during treatment remains insufficiently understood. We examined change in Big Five scores and depression during inpatient care and tested whether personality trait expression was associated with symptom-specific depressive change. In this naturalistic study, 334 inpatients with affective or psychotic disorders at a German University Hospital completed Beck Depression Inventory and Big Five Inventory-2-XS across three to five assessments. Coordinated change in depression severity and personality scores was examined using bivariate latent growth models. To capture symptom-level heterogeneity, proportional-odds ordinal mixed-effects models were fitted for each BDI item using average personality scores across treatment as moderators. Depression severity decreased over treatment. Growth models showed coordinated change between depression and several personality trait scores: reductions in Neuroticism and increases in Agreeableness, Conscientiousness, and Extraversion were associated with greater reductions in depression severity. At the symptom level, higher average Neuroticism was associated with slower improvement across a broad range of affective, cognitive, somatic, and functioning-related symptoms. Higher average Agreeableness and Extraversion were associated with faster improvement in selected symptoms, while Openness showed limited symptom-specific associations and Conscientiousness showed no significant moderation effects. Self-reported personality trait scores and depression show coordinated change during inpatient treatment. Symptom-level analyses suggest that depressive symptom trajectories differ according to average personality trait expression across treatment. These findings highlight the potential value of integrating personality assessment with symptom-level monitoring, while underscoring that the observed associations are non-causal and should not be interpreted as baseline prediction.
Thierry de Martel was a pioneer of French neurosurgery and a decorated World War I veteran. During World War II, he organized and modernized neurosurgical care for French soldiers at the American and Laennec Hospitals in Paris. As the German army advanced in June 1940, de Martel, aged 64, sought to join a last-ditch resistance effort. Disillusioned by France's military defeat and political collapse and burdened by the death of his only son in World War I, he took his own life on June 14, 1940, the day German troops entered Paris. This article reconstructs the final weeks of de Martel's life through archival materials, medical records, and eyewitness accounts, offering a unique historical perspective on the ethical, emotional, and professional dilemmas faced by physicians during wartime. De Martel's final act was both a protest and a legacy-a message of surgical precision, patriotic despair, and moral clarity. His story resonates today as a testament to the enduring tension between duty to life and devotion to country.