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Explanations of societal polarization often rely on one of three mechanisms: homophily, bounded confidence, and community-based interactions. Opinion dynamics models based on these mechanisms consider the lack of interactions as the main cause of polarization. Given the increasing connectivity in modern society, this explanation of polarization may be insufficient. To understand how society becomes more polarized as its connectedness increases, we propose a voter-type model (called I-voter) that incorporates involvement as a key mechanism in opinion formation and study its dependence on the network connectivity. We describe the steady-state behavior of the model analytically, at the mean-field and the moment-hierarchy levels, and stress the generality of our findings by considering various extensions and different network topologies.

This report examines the evolution of Spain's relationship with Europe and the European Union (EU), as well as the rise and impact of populism and Euroscepticism within its political system. Following the democratic transition, European integration became a central pillar of Spain's modernization and political legitimization, supported by a broad consensus among both elites and public opinion. Since joining the European Economic Community in 1986, support for the EU has remained consistently high, albeit sometimes characterized by limited public engagement. This consensus began to weaken after the 2008 financial crisis, which created opportunities for the emergence of new populist actors. In this context, Podemos on the radical left and Vox on the radical right gained prominence. Both parties incorporate elements of Euroscepticism, though in distinct ways. Podemos advances a form of soft Euroscepticism, criticizing neoliberal EU policies and political elites while maintaining a fundamentally positive view of the European project and advocating institutional reform. In contrast, Vox promotes a more nationalist and confrontational discourse, portraying EU elites as part of a "globalist" agenda and advocating a restructuring of the EU toward greater national sovereignty. Despite the rise of these challengers, mainstream parties-namely the PSOE and the PP-have maintained strong pro-European positions. Although they have adopted partially accommodative strategies in response to political competition, they have not significantly altered their support for European integration. Overall, Spain continues to exhibit a predominantly pro-EU political system and public opinion, where Euroscepticism, while increasingly visible, remains largely moderate in nature.

Advances in paediatric intensive care have resulted in a growing population of survivors exposed to long-term morbidity. Paediatric post-intensive care syndrome (PICS-p) encompasses new or worsened physical, cognitive, psychological/psychiatric, and socio-familial impairments that may affect children and their families after discharge from the paediatric intensive care unit (PICU). Despite increasing recognition of PICS-p, post-PICU follow-up remains highly heterogeneous worldwide, and systematic screening and management strategies are rarely integrated into routine care. These guidelines were issued at the initiative of the French national health authority (Haute Autorité de Santé: HAS) to improve the prevention, identification, and management of PICS-p. Clinical practice guidelines developed following the HAS standardized methodology (Recommandations de Bonne Pratique), including systematic literature review, multidisciplinary expert elaboration, formal external review, and HAS board approval. Reporting follows the AGREE II framework. Clinical questions were predefined by HAS project leads. A systematic literature search ([dates]) was conducted across Embase, EmCare, Medline, and the Cochrane Library, prioritising guidelines, meta-analyses, and systematic reviews. Two field experts drafted initial recommendations, graded A (established evidence) to Expert Opinion (absence of evidence). An 18-member multidisciplinary working group refined the draft through two in-person meetings. A 52-member external review panel formally voted on agreement for each recommendation. The final version was approved by the HAS board. Fourty recommendations were issued: 5 with a moderate level of evidence (grade B), 8 low level (grade C) and 27 very low (expert opinion). Strong agreement by the panel of experts was achieved for all recommendations except for one (moderate). The recommendations define PICS-p as a prevalent, multidimensional condition and emphasize systematic, repeated screening of children and families from PICU admission through the first year after discharge. Key preventive strategies include implementation of ABCDEFGH bundle, early mobilization, optimized analgesia and sedation, delirium prevention, and family-centred psychological support. Structured care pathways and pragmatic screening tools are proposed to ensure continuity of care. These guidelines emphasize the importance of structured, multidisciplinary, and family-centred strategies, to improve the prevention, early identification, and management of PICS-p and optimize long-term outcomes for children and their families.

This is an Opinion piece. Originally written as part of the ACPGBI undergraduate essay competition and adapted for this manuscript submission. This piece examines how AI and automation are reshaping colorectal surgical practice, arguing that safe integration requires preserving human competence, maintaining surgeon accountability and ensuring systems remain interpretable and readily overridable.

What is this summary about? This summary explains what both people living with hepatitis C and doctors think is meaningful when treating hepatitis C in Japan. We asked people living with hepatitis C and doctors about their opinions on hepatitis C treatment using a questionnaire. What was the study question? "What do people living with hepatitis C in Japan and their doctors consider most meaningful when choosing treatment?" Why was it asked? Understanding what people living with hepatitis C and doctors value when choosing hepatitis C treatment may help support continuing treatment, which is important for eliminating hepatitis C. What were the results? Among 95 people living with hepatitis C and 118 doctors, both groups thought that the total out-of-pocket costs for hepatitis C treatment was the most meaningful thing. Safety was ranked as the next most meaningful thing. People living with hepatitis C were more concerned about costs for treatment and less concerned about side-effect risks than doctors. People living with hepatitis C cared more about the number of tablets they had to take each day than the duration of treatment. For doctors, both were about the same. What do the results mean? For people living with hepatitis C, treatment costs are the most important concern. Improving awareness of Japan's financial assistance programs may help reduce out-of-pocket costs for hepatitis C treatment, thereby making it easier for people living with hepatitis C to receive treatment. Providing care that is adjusted to the situations, concerns, and treatment goals of people living with hepatitis C may help reduce barriers and gaps in hepatitis C treatment. Simple treatment options, such as one pill a day and/or minimized hospital visits during treatment course can make hepatitis C treatment more accessible. Good communication between people living with hepatitis C and doctors may help them make treatment decisions together, based on clear explanations of options and what matters most to people living with hepatitis C. In 2016, the World Health Organization (WHO) set a goal to eliminate HCV as a public health threat by 2030. These efforts will support achieving the goal in Japan.

Routine semen analysis provides limited diagnostic and prognostic insight into male reproductive potential, contributing to the increasing use of sperm DNA fragmentation (SDF) testing in fertility evaluation. However, the clinical application of SDF testing appears to outpace the strength and consistency of the supporting evidence. This opinion paper critically appraises SDF testing through established screening, diagnostic, and prognostic test-performance frameworks, drawing on published observational studies, meta-analyses, and international guideline statements across natural conception and ART. The available evidence indicates that SDF testing does not meet the criteria for population-level screening or for routine diagnostic or prognostic use in unselected infertile populations and is frequently applied beyond its validated scope. Interpretation is further limited by assay heterogeneity, lack of standardization, variable thresholds, reliance on surrogate outcomes, and the limited effectiveness of available interventions. Routine implementation therefore risks overdiagnosis, unnecessary interventions, and premature escalation to assisted reproduction without proven benefit. When applied selectively within an aetiology-driven framework, particularly in defined subgroups, SDF testing may provide adjunctive risk stratification rather than deterministic clinical guidance. All stakeholders must be made aware of these limitations before the test is offered, interpreted, or used to modify treatment.

Physical models aimed to reproduce basic features of the solar sunspot cycle are typically based on the solar dynamo mechanism. Usually qualitative arguments are used to define parameters of the model, among which a challenging component is the nonlinear form of quenching of the α effect governing regeneration of the magnetic field. We propose an approach, in which the functional form of the α quenching is represented by a neural network model embedded into neural differential dynamo equations trained on observational data. For demonstration, we consider a low-mode dynamo model and find a wide set of α-quenching functions and corresponding dynamo numbers that provide an accurate fit to the average profile of the solar cycle data given by sunspot numbers. Within this set, we observe a strong relationship between the dynamo number and the shape of the α-quenching function indicating that additional magnetic field data or constraints are essential to unambiguously infer parameters of the dynamo model. In our opinion, the neural differential approach opens a prospect for data-driven investigation of the closure problem in dynamo theory.

Following a request from the European Commission, the EFSA Panel on Nutrition, Novel Foods and Food Allergens (NDA) was asked to deliver an opinion on zinc l-carnosine as a novel food (NF) pursuant to Regulation (EU) 2015/2283 and as a source of zinc for use in food supplements. The NF is produced by chemical synthesis. The target population is individuals above the age of 12 years, excluding pregnant and lactating women. The NF which is the subject of the application is a chelate complex, formed between Zn2+ and l-carnosine. The material is a powder with a particulate nature and is insoluble in water at neutral pH. The Panel considers that the available data do not allow to exclude the presence of a fraction of small particles including nanoparticles in the NF under assessment and do not support its quick dissolution in gastric conditions. In addition, due to the limitations of the studies provided, the actual bioavailability of the zinc provided by the NF at the proposed use levels remains uncharacterised. The Panel concludes that the NF is insufficiently characterised and neither its bioavailability nor its safety can be established.

The use of life-support therapies like extracorporeal membrane oxygenation (ECMO), mechanical circulatory systems (MCS), and continuous renal replacement therapy (CRRT) creates a complex and dynamic metabolic environment that profoundly challenges nutritional management for these critically ill patients. Current existing guideline recommendations are largely based on expert opinions and observational data. No specific guidelines exist for this population. This mini-review synthesizes the current, limited evidence on the pathophysiological and metabolic alterations induced by ECMO, MCS, and CRRT and provides pragmatic recommendations for nutritional assessment and delivery. The key challenges include dramatic nutrient fluxes in the case of CRRT, a possible hypermetabolic state exacerbated by ECMO, fluid overload constraints, and drug-nutrient interactions. Practical strategies are proposed for calorie-protein targeting, micronutrient repletion, and monitoring, emphasizing a 'start low, advance carefully' approach within a multidisciplinary framework.

The Science of Team Science (SciTS) has an evidence problem. On the one hand, there are few studies demonstrating the effectiveness of evidence-informed team science trainings. On the other hand, SciTS has taken a relatively narrow view of what constitutes high-quality evidence of effectiveness. The field tends to privilege evidence generated from randomized controlled trials (RCTs), surveys of expert opinion, systematic reviews, and other methods of evaluation and assessment that are premised on narrow, experimental, or positivist understandings of what forms of knowledge are permitted to count as high-quality evidence. In this commentary, we suggest that SciTS ought to expand its understanding of what forms of knowledge can count as high-quality evidence. We argue that SciTS should include in-depth qualitative and ethnographic research programs that are not oriented around reproducibility or generalizability but instead focus on the value of specific studies, interpretive methods, and contextualized knowledge.

Heider balance theory provides a fundamental framework for understanding the formation of friendly and hostile relations in social networks. Existing stochastic formulations typically assume a uniform social temperature, implying that all interpersonal relations fluctuate with the same intensity. Howemver, studies show that social interactions are highly heterogeneous, with broad variability in stability, volatility, and susceptibility to change. In this work, we introduce a generalized Heider balance model on a complete graph in which each link is assigned its own social temperature. Within a mean-field formulation, we derive a distribution-dependent self-consistency condition for the collective opinion state and identify the criteria governing the transition between polarized and nonpolarized configurations. This framework reveals how the entire distribution of interaction heterogeneity shapes the macroscopic behavior of the system. We show that the functional form of the inverse temperature distribution, in particular whether it is light tailed or heavy tailed, leads to qualitatively distinct phase diagrams. We also establish universal bounds for the critical transition, where the homogeneous-temperature limit provides a universal lower bound for the critical mean of an inverse temperature distribution governing the transition. Numerical simulations confirm the theoretical predictions and highlight the nontrivial effects introduced by heterogeneity. Our results provide a unified route to understanding structural balance in realistic social systems and lay the groundwork for extensions incorporating fluctuations beyond mean field, external fields, and network topologies beyond the complete graph.

Genomic Newborn Screening (gNBS) could transform neonatal healthcare by enabling early detection of genetic disorders, timely intervention, and improved health outcomes. This study assessed healthcare professionals' self-reported knowledge, attitudes, and challenges regarding expanded newborn genomic screening in Abu Dhabi, United Arab Emirates (UAE), and identified factors influencing its integration into neonatal healthcare. A cross-sectional survey was distributed to healthcare professionals across public and private facilities in Abu Dhabi, using random and snowball sampling. Data were analyzed using descriptive statistics, chi-square tests, and logistic regression to examine associations between gNBS self-reported knowledge, attitudes, and professional characteristics. About 46% (95% CI: 40%-52%) of professionals demonstrated good self-reported knowledge of gNBS, with significantly higher awareness among those experienced in newborn screening and tandem mass spectrometry. While 70% supported expanding gNBS, key barriers included cost, lack of screening guidelines, and ethical concerns such as genetic privacy and psychological distress for families. Most participants (85%) supported upskilling nurses and midwives for cord blood collection. Additionally, severe combined immunodeficiency (SCID), Duchenne muscular dystrophy (DMD), and spinal muscular atrophy (SMA) were essential conditions for inclusion in expanded gNBS programs. Healthcare professionals in Abu Dhabi recognize the potential of gNBS but also acknowledge key implementation challenges. Advancing implementation requires training, policy development, and ethical considerations. Future efforts should prioritize cost-effectiveness evaluations, regulatory frameworks, and stakeholder engagement to support sustainable and equitable gNBS implementation in the UAE.

Multiple non-androgen long-term prophylaxis (LTP) therapies have been approved in the United States to prevent hereditary angioedema (HAE) attacks. Real-world data on treatment compliance, healthcare resource utilization (HRU), and costs in this population are limited. Assess LTP treatment patterns, associated HRU, and costs in patients with HAE using a national claims database. Commercially insured patients from the IQVIA PharMetrics® Plus Closed Health Plan Claims Database (January 2016-September 2023) had ≥1 claim for non-androgen LTP, with ≥6 months of continuous enrollment pre-index and ≥12 months post-index (first LTP claim). Patient cohorts: no/minimal refill gaps, with refill gaps, or switchers. Annualized mean on-demand therapy claims, HRU, and costs were evaluated 12 months pre- and post-index. A total of 328 patients were included in this analysis. Most patients (67%) had ≥1 post-index on-demand therapy claim. Mean (SD) annualized on-demand therapy doses pre- and post-LTP, respectively, were 20.8 (25.1) vs 12.4 (15.2) (P=0.001) with no/minimal refill gaps (n=147); 18.3 (19.7) vs 18.0 (22.3) (P=0.769) with refill gaps (n=131); and 25.7 (28.7) vs 29.2 (28.8) (P=0.12) for switchers (n=50). During follow-up, 17% and 8% had ≥1 HAE-related ER and inpatient visit, respectively. Mean annualized total HAE-related healthcare costs per patient were $165,348 pre-LTP and $515,333 post-LTP, driven by increased LTP pharmacy costs (mean $395,845 PPPY) and partially offset by reductions in medical costs (ER/inpatient, mean $8344 PPPY). This study found that 55% of patients had refill gaps in LTP claims, discontinued, or switched LTP within a year of initiation. Even with use of LTP, on-demand treatment utilization remained present for over two-thirds of patients. Substantial increases in total HAE-related healthcare costs were driven by LTP pharmacy costs, without significant reductions in HRU. These findings highlight the importance of monitoring and optimizing treatments for those living with HAE and ensuring access to on-demand treatment for all as the foundation for HAE management.

Alzheimer's disease (AD) accounts for a significant proportion of health and social care costs. We studied family caregiver (FC), care recipient (CR), and formal care provider-related factors, which are associated with the cost of care in different stages of AD in Finland. A 5-year follow-up was conducted with 231 individuals with AD (CRs) and their FCs as a part of the ALSOVA project. The data was collected between 2002 and 06. Significant factors associated with costs were identified using a stepwise backward elimination procedure. Neuropsychiatric symptoms were measured with the Neuropsychiatric Inventory (NPI). Across all stages of AD, each additional year of CR's education was associated with a 3.4% reduction in costs (rate ratio [RR] 0.966, 95% CI 0.940-0.993). Conversely, a one-point increase on the Neuropsychiatric Inventory was associated with a 1.8% increase in costs (RR 1.018, 95% CI 1.011-1.025). CR's neuropsychiatric symptoms (RR 1.028, 95% CI 1.010-1.047) and male FC (RR 1.756, 95% CI 1.266-2.437) were associated with increased total costs in early AD, CR's comorbidities (RR 1.138, 95% CI 1.068-1.212) and FC's burden (RR 1.032, 95% CI 1.012-1.053) in mild AD and FC being a spouse (RR 1.451, 95% CI 1.105-1.905) in moderate AD. No formal care provider-related factors were associated with total costs in any stage of AD. This study reveals several factors that may be manageable to control the costs of AD. Comprehensive prevention, evaluation, and treatment of a CR's neuropsychiatric symptoms and comorbidities should be executed early. Informal care can act as a substitute for formal care in early-stage AD, and supportive measures toward FCs should be considered. To study family caregiver, care recipient and formal care provider-related factors associated with the cost of care in different stages of Alzheimer's disease in Finland. Care recipient’s neuropsychiatric symptoms and family caregiver being a male were associated with total costs in early Alzheimer’s disease, care recipient’s comorbidities and family caregiver’s burden in mild Alzheimer’s disease and family caregiver being a spouse in moderate Alzheimer’s disease. No formal care provider-related factors were associated with total costs in any stage of Alzheimer’s disease. It is important to understand factors associated with the cost of care in different stages of Alzheimer’s disease so that costs can be properly managed and timely support can be provided for individuals with Alzheimer’s disease and their family caregivers.

The emergence of high-cost therapies, particularly in oncology, rare diseases, and advanced therapy medicinal products, has increased the need for robust pharmacoeconomic evaluations to support healthcare decision-making. These innovative interventions often promise substantial clinical benefits but also pose challenges due to limited long-term data, high upfront costs, and uncertain cost-effectiveness. This narrative review critically examines key pharmacoeconomic frameworks, e.g. cost-effectiveness analysis and cost-utility analysis, and highlights their limitations in assessing such novel therapies. The role of real-world evidence, advanced modeling techniques, and patient-reported outcomes is explored, alongside the ethical and policy considerations that arise in pricing, access, and reimbursement. Recent literature and case studies involving gene and cell therapies are reviewed, illustrating the complexity of determining value under uncertainty. The paper advocates for a more flexible, transparent, and patient-centered approach to health technology assessment, integrating societal values and dynamic reassessment mechanisms. Such strategies are essential for achieving sustainable access to high-value therapies while maintaining health system efficiency and equity.

Effective communication with paediatric patients is one of the cornerstones of paediatric dentistry. Strong communication skills play a critical role in reducing dental anxiety, enhancing patient satisfaction, and facilitating the overall treatment process. This study aimed to assess the verbal and nonverbal communication skills of paediatric dentists working across Turkey and to explore variations based on demographic variables. This descriptive cross-sectional study was conducted through an online questionnaire completed by 331 actively practising paediatric dentists in Turkey. The questionnaire included items structured on a 5-point Likert scale designed to evaluate communication competencies. Data were analysed using IBM SPSS Statistics 25.0. Descriptive statistics (frequency, percentage, mean) were used to summarise the participants' responses, and comparative analyses were performed based on selected variables (eg, gender, years of professional experience, parenthood status). The Mann-Whitney U test was applied for comparisons between two groups when parametric test assumptions were not met. Furthermore, questionnaire items were grouped under specific sub-dimensions of communication and presented thematically. A significance level of P 0.05 was adopted. Overall, participants reported a high level of perceived self-efficacy regarding their communication skills. Communication scores of faculty members and private practitioners were significantly higher than those of research assistants (P 0.001). A significant positive correlation was found between years of clinical experience and communication competencies (P 0.01). Notably, younger clinicians scored lower in subdomains such as the use of 'I-messages' and democratic guidance. While the communication skills of paediatric dentists appear to be generally strong, younger clinicians may require further support in developing certain experience-based communication strategies. These findings highlight the need to integrate structured and practice-oriented communication training into both undergraduate and postgraduate dental education.

Due to the spread of misinformation that some vaccines cause autism spectrum disorder (ASD), many parents report changes in their vaccination behavior following a diagnosis of ASD, putting their children at increased risk for preventable diseases. Our study aimed to determine the rate of vaccination-related concerns and refusal behaviors in parents of children with ASD and non-autistic developmental delays (non-ASD-DD) and to examine factors potentially associated with vaccine hesitancy and refusal. In our study, a questionnaire was distributed to all parents of children diagnosed with ASD and non-ASD-DD who attended outpatient check-ups over 3 months at the Child Psychiatry Clinic of the two large hospitals. Participants completed a structured questionnaire assessing self-reported vaccination behaviors before and after diagnosis, as well as separate Likert-scale items evaluating vaccine-related beliefs and attitudes. No parents declined participation, and all 154 eligible parents were included in the study. Among the respondents, 87.7% were mothers. The most common diagnoses were intellectual disability (41.6%) and ASD (31.2%). Reported vaccine refusal increased from 3.9% before diagnosis to 9.7% after diagnosis (p = 0.012). The main reason cited for hesitancy or refusal was the belief that vaccines had caused their child's neurodevelopmental condition. No independent associations were found between post-diagnosis vaccine hesitancy/refusal and parental education, income, source of vaccine information, or depression/anxiety scores. However, 88.3% of participants disagreed or strongly disagreed with the statement that vaccines cause ASD or developmental disorders.  Parental concerns about vaccines persist after a diagnosis of neurodevelopmental disorders. Tailored education and communication strategies are essential to support informed vaccine decision-making in these families and to prevent refusal for both diagnosed children and their siblings. • Persistent misinformation linking childhood vaccines-particularly the MMR vaccine-to autism spectrum disorder continues to influence parental attitudes toward vaccination. • Parents of children with ASD have been shown to exhibit higher rates of vaccine hesitancy, especially regarding vaccination of younger siblings. • Vaccine hesitancy and refusal were more frequently reported after the diagnosis of not only autism spectrum disorder but also other developmental delays, including intellectual disability and speech delay. • Although concerns about vaccines causing developmental disorders were common, vaccine refusal remained relatively uncommon and no independent predictors of post-diagnosis hesitancy or refusal were identified, highlighting the complex nature of parental vaccination decisions.

This study investigated the financial impact of introducing the once-daily single-inhaler triple therapy (SITT) fluticasone furoate/umeclidinium/vilanterol (FF/UMEC/VI) in Saudi Arabia for adult patients with uncontrolled asthma. The expected 5-year budget impact of introducing FF/UMEC/VI for asthma was modeled using an epidemiology-based approach that included both acquisition and efficacy-related costs. Year-on-year costs were estimated for 2026 through 2030. Changes in healthcare resource utilization after FF/UMEC/VI introduction were estimated from the expected change in asthma control reported in the Phase IIIa CAPTAIN trial. The perspective of the model was the Saudi national healthcare payer; only direct medical costs were included. The robustness of the model was tested using sensitivity and scenario analyses. It was estimated that in 2026, 12,108 patients in Saudi Arabia would receive FF/UMEC/VI, which will likely increase over subsequent years (2027: 29,615 patients; 2028: 31,191 patients; 2029: 32,938 patients; 2030: 34,727 patients), as validated by local expert opinion. The introduction of FF/UMEC/VI was estimated to save a total of United States Dollars (USD) 10,654,389 over 5 years, or USD 16.32 per patient, with savings increasing each year after introduction. Drug acquisition costs contributed to the greatest impact on the budget, and the model was most sensitive to changes in the market uptake of FF/UMEC/VI. Across all sensitivity and scenario analyses, FF/UMEC/VI was consistently cost saving. Various model inputs could not be derived from published sources, so multiple assumptions were used. Future market share was estimated from current competitor market share data; as FF/UMEC/VI is the first SITT for asthma to be introduced into Saudi Arabia, there is no historical data on which to base these estimates. Introducing FF/UMEC/VI in Saudi Arabia has the potential to deliver meaningful clinical and economic benefits at both the individual patient and healthcare system level.