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Background Methods Results Conclusions The number of patients with dementia who are granted euthanasia or assisted suicide (EAS) increases yearly in the Netherlands. By law, patients need to be decisionally competent or have an advance directive. Assessment of decisional capacity is challenging as dementia progressively affects cognitive performance. We aimed to assess qualitatively which factors, and how, influence the judgment of decisional capacity in EAS cases with dementia.We performed a qualitative study of 60 dementia EAS case summaries published by the Dutch regional euthanasia review committees between 2012 and 2021. Included reports were evaluated using the grounded theory approach. All quotes related to decisional capacity were coded independently by two researchers and compared in an iterative process to formulate an overarching framework on the assessment of decisional capacity. We selected 20 patients who had an advance directive and were judged to be decisionally compromised, as well as a selection of 40 EAS cases judged to be decisionally competent, half of which also had an advance directive (purposive sampling).Decisional capacity was present in every case report. Predefined, external criteria were rarely described explicitly, but physicians indirectly referred to the (cognitive) criteria set by Appelbaum and Grisso. Whether the thresholds for these dimensional criteria were met was influenced by six supporting factors (level of communication, psychiatric comorbidity, personality, presence of an advance directive, consistency of the request, and, finally, the patient–physician relationship) that also directly contributed to the judgment of capacity. The involved physicians and executed investigations were the two contextual factors providing a background.Decisional capacity regarding euthanasia is a multidimensional construct, often implicitly assessed and influenced by supporting and contextual factors. The subjectivity of the final judgment poses ethical and legal issues and argues for continuous quality improvement processes. [ABSTRACT FROM AUTHOR]

ObjectiveMethodResultsConclusion\nKEY POINTSSome research suggests treatment outcome can be improved through more frequent therapy session scheduling. It is unknown how frequently Australian psychologists see their clients in routine practice. The present study investigated psychologists’ self-reported session-scheduling, attitudes, and perceived barriers towards more frequent scheduling.Using mixed methods, 246 psychologists completed an online survey, and 16 psychologists participated in qualitative interviews.Most psychologists had positive attitudes towards greater session frequency and perceived increased frequency to be associated with better outcomes, but a significant proportion scheduled sessions at suboptimal frequencies. Various barriers found confirmed previous literature findings, and enablers such as flexible scheduling and funding solutions were identified.Psychologists were willing to schedule sessions more frequently if sessions were more affordable to clients, and if they had a schedule able to accommodate more frequent sessions.What is already known about this topic: The prevalence of mental health in Australia has remained high over time.Weekly and greater frequency of therapy sessions is associated with better treatment outcomes for many clients and presentations.Some barriers may limit the capacity of psychologists to offer more frequent sessions.The prevalence of mental health in Australia has remained high over time.Weekly and greater frequency of therapy sessions is associated with better treatment outcomes for many clients and presentations.Some barriers may limit the capacity of psychologists to offer more frequent sessions.What this topic adds: Results indicated that session frequency is typically lower than ideal in routine psychology practice.In addition to barriers, various enablers conducive to more frequent scheduling were identified such as scheduling flexibility, strategic booking, funding solutions and reducing caseload.Strategies such as advocacy campaigns and increased education were identified as possible means to subvert these barriers.Results indicated that session frequency is typically lower than ideal in routine psychology practice.In addition to barriers, various enablers conducive to more frequent scheduling were identified such as scheduling flexibility, strategic booking, funding solutions and reducing caseload.Strategies such as advocacy campaigns and increased education were identified as possible means to subvert these barriers. [ABSTRACT FROM AUTHOR]

Background: Amyloid-targeting therapies for Alzheimer's disease (AD) might become available in Germany soon. The combination of a large pool of prevalent cases and a complex diagnostic process to determine eligibility for these treatments is likely to challenge health systems' capacity. Objective: To analyze Germany's healthcare system capacity to identify treatment-eligible patients in a timely and equitable manner. Methods: We modeled patients' diagnostic journey and projects wait times due to capacity constraints for AD specialist visits and PET scans from 2024 to 2043. Model parameters were derived from published data and expert input. Results: Wait times would be ∼50 months over the model horizon, if patients were referred to specialists based on a brief cognitive assessment in primary care. Wait times for patients with social health insurance are projected to be 1.9 times those of patients with private insurance, with peak wait times of around 76 and 40 months, respectively. Adding a blood test for the AD pathology as additional triage step would reduce wait times to below 24 months. Conclusions: In spite of having a well-resourced health system, Germany is projected to be unable to cope with the demand for biomarker-based AD diagnosis, if a disease-modifying AD treatment were introduced. As these treatments might become available by the end of 2024, decisive action, in particular dissemination of high-performing AD blood tests for triage in primary care, will be needed to prevent delays in access and potentially avoidable and inequitable disease progression. [ABSTRACT FROM AUTHOR]

A linear high‐sensitivity response is crucial for flexible electronic skin, particularly in precision detection for applications like intelligent robotics and human‐machine interactions. Prevailing strategies typically adopt a layered, multifaceted material design to cultivate this response, yet this approach often culminates in a diminished capacity to augment sensing stability. The root causes of these limitations are predominantly material mechanical mismatches and interface incompatibilities inherent in these designs. To address these challenges, an electromechanical integration strategy is introduced that simultaneously enhances linear highsensitivity and stability. This strategy is centered on constructing a robust, integrated mechanical and electrical interface within a polyurethane material system through an in situ growth and adhesion process. The iontronic pressure sensor exhibits a linear high‐sensitivity response (16.24 kPa−1, R2 = 0.999) within a wide range (0–300 kPa). Moreover, the sensor's integrated structure, self‐encapsulated through the adhesion between the electrode and dielectric layers, exhibits robust stability, even under complex mechanical stresses. The applications of the sensors in precision weighing and haptic feedback within intelligent gripping systems demonstrate their advantages of both linearity and stable sensing. This work delineates a strategic pathway for the fabrication of high‐performance flexible pressure sensors, contributing significantly to the field of advanced sensing technologies. [ABSTRACT FROM AUTHOR]

Background: Intrinsic capacity (IC) was introduced by the World Health Organization (WHO) as a marker of healthy aging, and is defined as the combination of an individual's physical, mental, and psychological capacities. This study aimed to assess IC via a patient‐reported geriatric assessment (GA) and evaluate its association with survival among older adults with gastrointestinal (GI) malignancies. Methods: Data were used from a single‐institution prospective registry of older adults undergoing GA before cancer therapy. Key domains of IC (vitality, locomotion, and sensory [hearing and visual], psychological, and cognitive capacities) were captured via GA, and each was given a score of 0 or 1 (0, impaired) to compute the total IC score (range, 0–6, where 6 indicates no impairment and ≤5 indicates impairment in ≥1 domains). A frailty index (FI) was measured via the deficit accumulation method. Cox regression models and Kaplan–Meier curves were used to examine the impact of IC impairment on survival. Results: The study included 665 patients; the median age was 68 years, 57.4% were men, and 72.9% were White. The median IC score was 4, and 79.3% of participants showed impairment in ≥1 domains of IC. Most commonly impaired domains were locomotion (48.7%) and vitality (43.9%). IC was inversely associated with FI (Spearman coefficient, −0.75; p <.001). IC impairment was associated with inferior overall survival (score, 4–5: adjusted hazard ratio [aHR], 1.7; 95% CI, 1.11–2.48; score, 2–3: aHR, 1.9; 95% CI, 1.30–2.85; score, 0–1: aHR, 1.9; 95% CI, 1.11–2.48). Conclusions: IC impairment is associated with frailty and reduced overall survival in older patients with GI malignancies. GA can be used to screen for IC impairment as recommended by the WHO. Plain Language Summary: The World Health Organization introduced intrinsic capacity as a marker of healthy aging.Intrinsic capacity is the combination of an individual's physical, mental, and psychological capacities. It contains six key domains: vitality, locomotion, and sensory (hearing and visual), psychological, and cognitive capacities.Older adults with cancer are susceptible to a decrease in intrinsic capacity as a result of cancer and the aging process.In this study, we aimed to assess the intrinsic capacity for patients with gastrointestinal cancer and also identify whether there exists any association of intrinsic capacity with overall survival. We identified that approximately 80% of this population had one or more impaired domains, and more intrinsic capacity impairment was associated with reduced overall survival. Geriatric assessment can be used to screen for intrinsic capacity impairment as recommended by the World Health Organization. In older patients with gastrointestinal malignancies, intrinsic capacity impairment is common and associated with frailty and reduced overall survival. [ABSTRACT FROM AUTHOR]

Copyright of Umsatzsteuer-Rundschau is the property of De Gruyter and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

Background: The role of ELAVL1 in the progression of various tumors has been demonstrated. Our research aims to investigate how ELAVL1 controls the glycolytic process in nasopharyngeal carcinoma cells through the HMGB3/β-catenin pathway. Methods: The expression of ELAVL1 was detected in clinical tumor samples and nasopharyngeal carcinoma cell lines. A subcutaneous tumor model was established in nude mice to investigate the role of ELAVL1 in tumor progression. The relationship between HMGB3 and ELAVL1 was validated by RNA pull down and RIP assays. TOPFlash/FOPFlash reporter assay was used to detect β-catenin activity. Assay kits were utilized to measure glucose consumption, lactate production, and G6PD activity in nasopharyngeal carcinoma cells. Western blot was conducted to detect the expression of glycolysis-related proteins. The glycolytic capacity was analyzed through extracellular acidification rate (ECAR). Results: In both clinical samples and nasopharyngeal carcinoma cell lines, the expression levels of ELAVL1 mRNA and protein were found to be upregulated. Knockdown of ELAVL1 significantly inhibited the in vivo proliferation of nasopharyngeal carcinoma and suppressed the glycolytic capacity of nasopharyngeal carcinoma cells. ELAVL1 interacts with HMGB3, leading to an increase in the stability of HMGB3 mRNA. Overexpression of HMGB3 elevated the reduced β-catenin activity caused by sh-ELAVL1 and reversed the inhibitory effect of sh-ELAVL1 on cellular glycolytic capacity. Treatment with β-catenin inhibitor (FH535) effectively suppressed the promotion of glycolytic capacity induced by HMGB3 overexpression. Conclusions: ELAVL1 promotes glycolysis in nasopharyngeal carcinoma cells by interacting with HMGB3 to stabilize HMGB3 mRNA, thereby activating β-catenin pathway. Therefore, targeting the ELAVL1-HMGB3-β-catenin axis has the potential to be a novel approach for treating nasopharyngeal carcinoma. Highlights: ELAVL1 promotes glycolysis in nasopharyngeal carcinoma cells. ELAVL1 interacts with HMGB3, thereby activating β-catenin pathway. HMGB3 is involved in ELAVL1-mediated glycolysis in nasopharyngeal carcinoma cells. HMGB3 promotes glycolysis by activating β-catenin pathway in nasopharyngeal carcinoma cells. [ABSTRACT FROM AUTHOR]

AbstractThe issue of medically-assisted dying in pediatric care, including euthanasia and deep sedation, is ethically complex. Despite its relevance, no research has applied Information Integration Theory to evaluate the acceptability of these practices in pediatric care, which is what we did in the present study. A sample of 166 French laypeople read 54 scenarios involving end-of-life situations involving children and assessed the acceptability of a physician’s decision in each one. Scenarios included four factors: child’s discernment capacity, child’s request to die, parental consent, and physician’s action. Parental consent and the child’s request were the most influential factors in respondents’ judgments, followed by the child’s discernment and physician’s action. Cluster analysis revealed four groups: “Situation-dependent,” “Always acceptable,” “Not acceptable except in rare circumstances,” and “Parental consent.” Most people were sensitive to situational factors influencing the acceptability of children’s medically assisted dying. [ABSTRACT FROM AUTHOR]

We conducted a scoping review to ascertain the landscape of ethics regulations for AD/ADRD research in Africa using Arksey and O'Malley's framework. We sourced regulations from the International Compilation of Human Research Standards. We included regulations from 14 countries published between 1997 and 2020. Provisions in the regulations applicable to research in AD/ADRD were part of broader sub‐provisions for research such as with persons under legal disability. Regulations mostly required the appointment of Legally Authorised Representatives, as a major protection for persons with AD/ADRD. Provisions supporting capacity assessment and advance directives were only provided in regulations from five and two countries respectively. No regulation cited the Convention on the Rights of Persons with Disabilities as a foundational instrument for its provisions. In conclusion, regulations specifically applicable to research among AD/ADRD or other cognitively impaired persons in Africa are scarce and provisions in existing regulations mostly lack specificity for practical implementation. [ABSTRACT FROM AUTHOR]

Morphometric analysis of previously unresearched tributary junction fans (TJFs) of the Spiti valley cold desert, India, was conducted to understand the factors influencing their development. An integrated remote sensing and field approach was employed, including the development of multi-method morphometric indices viz. fan conicality (FCI), sweep angle (SA), fan width-to-length ratio (W/L), feeder stream-order and valley floor width-to-height ratio (Vf). Such TJFs, which are the most suitable cultivation and settlement sites in this region, were found to be largely polygenic and planimetrically confined, with many being multi-staged in terms of their development. The results of morphometric analyses reveal that the TJFs are relatively smaller but steeper than their counterparts in other settings, with high relative topographic confinement causing the construction of smaller and steeper fans. The competence of the feeder stream, along with associated processes, notably influences fan morphology using differential sediment transporting capacity. TJFs created by more competent streams are less steep, more influenced by topographic confinement and more vulnerable to truncation by the trunk stream. Furthermore, tectonically induced base-level fall and resultant downcutting in confined environments have caused the formation of truncated, multi-staged and entrenched fans and are primarily responsible for coupling between TJF catchments and trunk stream in the study area. [ABSTRACT FROM AUTHOR]

Background: Advance research directives (ARDs) provide a promising way to involve individuals with mild cognitive impairment (MCI) in research decisions before they lose the capacity to consent. At the same time, the views of people with MCI on ARDs are underexplored. This study assesses the perceptions of people with MCI and family members on the benefits and challenges associated with ARDs. Aims: The aim of this study was to investigate the perspectives of individuals with MCI and family members of individuals with MCI on ARDs. We focus specifically on willingness to participate in nontherapeutic research, understanding of ARDs and the ethical considerations involved. Methods: Thirteen open-ended, face-to-face interviews were conducted using a semi-structured format. Seven interviews were conducted with individuals with MCI, and six with family members of individuals with MCI. The narratives were transcribed verbatim and qualitative content analysis was carried out. Results: Research participation and ARDs were viewed positively, largely based on altruistic motives and the desire to contribute to society. The participants recognized the potential advantages of ARDs in reducing the decision-making burden on family members and maintaining personal autonomy. They also highlighted challenges in comprehending ARDs and navigating the complexities surrounding potential conflicts between current preferences versus preferences described in an ARD.Conclusions: ARDs were predominantly seen as valuable instruments that enable individuals with MCI to participate in research. This study provides insights into the reasons why affected individuals are interested in drafting ARDs. These insights can guide the development of supportive interventions that are tailored to assist individuals with MCI and their families in navigating ARD processes. [ABSTRACT FROM AUTHOR]

Background: Advance healthcare decision-making presumes that a prior treatment preference expressed with sufficient mental capacity ("T1 preference") should trump a contrary preference expressed after significant cognitive decline ("T2 preference"). This assumption is much debated in normative bioethics, but little is known about lay judgments in this domain. This study investigated participants' judgments about which preference should be followed, and whether these judgments differed depending on a first-person (deciding for one's future self) versus third-person (deciding for a friend or stranger) perspective. Methods: A vignette-based survey was conducted (N = 1445 US Americans; gender-balanced sample), in a 3 (relationship: self, best friend, stranger) × 2 (T1 preference: treat, do not treat) × 2 (T2 contrary preference: ambiguous, unambiguous) design. Results: Participants were more likely to defer to the incapacitated T2 preference of a third-party, while being more likely to insist on following their own T1 capacitated preference. Further, participants were more likely to conclude that others with substantial cognitive decline were still their "true selves," which correlated with increased deference to their T2 preferences. Conclusions: These findings add to the growing evidence that lay intuitions concerning the ethical entitlement to have decisions respected are not only a function of cognition, as would be expected under many traditional bioethical accounts, but also depend on the relationship of the decision to the decision-maker's true self. [ABSTRACT FROM AUTHOR]

How do humans build and navigate their complex social world? Standard theoretical frameworks often attribute this success to a foundational capacity to analyze other people's appearance and behavior to make inferences about their unobservable mental states. Here we argue that this picture is incomplete. Human behavior leaves traces in our physical environment that reveal our presence, our goals, and even our beliefs and knowledge. A new body of research shows that, from early in life, humans easily detect these traces—sometimes spontaneously—and readily extract social information from the physical world. From the features and placement of inanimate objects, people make inferences about past events and how people have shaped the physical world. This capacity develops early and helps explain how people have such a rich understanding of others: by drawing not only on how others act but also on the environments they have shaped. Overall, social cognition is crucial not only to our reasoning about people and actions but also to our everyday reasoning about the inanimate world. [ABSTRACT FROM AUTHOR]

Evaluation and strengthening of existing bridges – historical outlines and findings regarding the Hessian road bridge inventory Two short histographical sketches introduce the concepts of refurbishment, condition and load‐bearing capacity assessment between 1700 and 2010 and take a look at the development of the recalculation of existing bridges. Based on project sketches, the hidden safety features of existing road bridges are worked out and procedures for achieving efficient structural bridge strengthening are presented. The focus is on the determination of real object‐specific traffic load models, calibrated structural analyses and additive and non‐destructive strengthening methods. Some critical comments on planning acceleration and the current approval system, together with the demand that bridge construction should be reflected in the common objective of "traffic", broaden the definition of strengthening holistically. This offers the opportunity to stimulate a discussion about the sensible handling of existing bridges as part of our road infrastructure. [ABSTRACT FROM AUTHOR]

Problem, research strategy, and findings: Although theory and practice contend that local knowledge improves climate adaptation planning, little research has documented the kinds of information shared by residents. Planners can use this information to assist in the creation of planning processes and tools, as well as investigate how local knowledge contributes—or does not contribute—to planning outcomes. We developed a provisional typology of how local knowledge has been used for adaptation planning and used a case study to ask: When compared with existing research, what information do residents share? How might this knowledge be useful for climate adaptation? In interviews, residents identified new ideas about local knowledge and climate adaptation planning: cascading harms and repeated trauma from—and mental health implications related to—climate events, lack of trust in municipalities, and how community capacity increases climate adaptation. Although these themes support existing research, to our knowledge, these findings are the first empirical data from studies focused on local knowledge in which frontline residents themselves identified the need for increased attention to mental health, community capacity, and trust building. Our findings contribute to larger conversations about climate adaptation planning as well as help inform the development of an adaptation tool in Austin (TX). Takeaway for practice: We identified three takeaways for climate adaptation planning: increase acknowledgment of and attention to mental health effects, integrate local knowledge about community capacity, and consider incorporating local knowledge to build trust. [ABSTRACT FROM AUTHOR]

Based on the development of a theoretical framework adapted to the field of higher education, and the validation of a questionnaire designed to assess the innovative competence profile of teachers, the research carried out was aimed at detecting the level of capacity of university teaching staff in Spain to introduce improvements in learning methodologies for innovation in the classroom. To this end, a sample of 398 teachers from some Spanish universities were given the instrument (.967 in Cronbach's α), obtaining an average of 2.978 (Likert 1-5) in the innovative competence, which indicates that there is a profile below the average. [ABSTRACT FROM AUTHOR]

In the last years, we have attended to different attempts to extend the notion of affordance to include mental or cognitive actions. In short, the idea is that our capacity to perform some cognitive functions such as counting, imagining, mathematical reasoning, and so on, is preceded by our awareness of cognitive or mental affordances. In this paper, we analyze two of these attempts, Mental Affordance Hypothesis, and cognitive horizons, and conclude that they fail to deliver their promise. Our argument is two-fold. First, we show that both proposals lack an explanation for how these affordances can be perceived or experienced by the individuals. Second, we argue, focusing on the examples provided by the authors, that the introduction of cognitive affordances is not justified on explanatory grounds. In other words, neither of these proposals offers a compelling justification for thinking that performing said "mental acts" requires the perception of mental or cognitive affordances. Hence, the existence of mental or cognitive affordances remains both scientifically mysterious and explanatorily unjustified. [ABSTRACT FROM AUTHOR]

Background: People with severe brain injuries (PSBI) and reduced capacity to consent (CTC) frequently develop muscle contractures. Standard care includes prolonged stretch (PS) but there is limited condition-specific evidence from randomized controlled trials (RCTs). Purpose: Identify factors affecting the inclusion of PSBI and reduced CTC in a PS RCT and methodologies more capable of generating condition-specific outcomes. Methods: Mixed-method feasibility studies, including a pilot RCT (PSBI, adults with reduced CTC) comparing PS treatments (serial casting and splinting) and focus groups/interviews with physiotherapists involved in PS treatment. Reflexive thematic analysis developed themes. Results: Two PSBI were included in the pilot RCT with no significant safety concerns or adverse effects. Twelve physiotherapists participated in two focus groups and two interviews. Four themes were identified: 1) complexity of contracture management; 2) burden of decision making; 3) lack of evidence and uncertainty; and 4) challenges to RCT acceptability and feasibility. Conclusions: Reduced CTC contributes to the exclusion of PSBI from experimental research, and a circular paradox where poor research inclusion contributes to generalized healthcare and "evidence-biased medicine." Due to the complexity of their condition, simply including PSBI in randomized research is unlikely to create meaningful health outcomes. Improving their care requires a paradigm shift toward pluralistic methods of knowledge generation. [ABSTRACT FROM AUTHOR]

INTRODUCTION: What do surgeons want to know about law pertaining to their practice? We have found nothing in the literature to address this subject. We present evidence to answer our question. METHODS: A retrospective review was conducted of all enquires to a clinical law service in a university hospital between 2009 and 2023. Each 'case' originating from a surgeon was categorised according to its fundamental legal phenotype. RESULTS: A total of 1,476 enquiries relating to clinical law were received from the clinical workforce in the hospital and the region. Of these, 154 enquiries (13%) were made by surgeons representing all 10 specialty groups and dentistry. The largest groups of enquiries related to professional conduct (n=49), competence/capacity (n=33), consent (n=23) and refusal of treatment (n=23). The incidence of the surgical enquiries relating to refusal of care, consent, standards of care and capacity mirrored those made by non-surgical specialties. The surgical enquiries concerning confidentiality, candour and withdrawal of treatment were notably infrequent. We discuss the detail of some of the clinical scenarios arising from these enquiries that reveal the breadth and depth of legal complexities faced by surgeons of all specialties. CONCLUSIONS: Patterns or phenotypes of surgical legal dilemmas have emerged that could provide a framework for preparing surgeons to deal better with the patient in front of them. Enquiries indicative of what surgeons want to know suggest gaps in surgical legal knowledge that may be a focus of future education. Near-absence of enquiries in candour and confidentiality are notable, without immediate explanation. [ABSTRACT FROM AUTHOR]

Objectives: This study explored participant experience of mentalization after the completion of an introductory MBT group within an Irish prison. Methods: Data were collected from four participants using semi-structured interviews which were analyzed according to IPA methodology. Results: Four group experiential themes were identified from the data: making sense of difficulties with emotions in the context of early life experiences, learning to feel and manage emotions, keeping other minds in mind and mentalizing in practice. Conclusions: This study adds to the wider qualitative literature on MBT and presents a unique insight into participant experiences of developing their mentalizing capacity within a prison setting. [ABSTRACT FROM AUTHOR]

Courts rely heavily on the recommendations of mental health evaluators when making decisions about competency (e.g., Zapf, Hubbard, Cooper, Wheeles, & Ronan, 2004), including civil competency (e.g., Quickel, Demakis, & Reeve, 2017); however, very little is known about how evaluators arrive at their opinions regarding an individual's capacity. The current study assessed clinical decision-making using a policy capturing methodology. An ecologically valid sample (N = 47) of predominantly white (87.23%) and female (55.30%) clinicians who were eligible to conduct civil competency evaluations in North Carolina were recruited to examine the degree to which five key factors (functional test data, cognitive test data, personality test data, hospitalization history, and/or medication compliance) influenced clinician competency determinations. Personal insight into one's decision-making process was also measured. Consistent with previous research, functional test data was weighted most heavily in evaluator decisions, though all five factors were considered. Further analysis suggested variable levels of self-awareness of one's decision-making policies by participants depending on the factor. In addition, there was high agreement among clinicians when cases were straightforward, but perfect disagreement (half recommending competency, half recommending incompetency) among clinicians when cases were more complex. Implications for civil competency assessment and decision-making are discussed. IMPACT STATEMENT: Functional assessment data drives clinician decisions regarding civil capacity, over and above the impact of cognitive and personality test data, hospitalization history, and medication compliance. Due to high levels of court reliance on the recommendation of clinical evaluators, and the different standards of civil competency across different states and jurisdictions, understanding how evaluators arrive at competency recommendations is imperative and has clinical, legal, and ethical implications. [ABSTRACT FROM AUTHOR]

In an ageing world with a growing prevalence of neurodegenerative disease and recent voluntary assisted dying laws in New Zealand and several Australian states, healthcare professionals are increasingly being relied upon to conduct decision-making capacity (DMC) assessments. There is no legislation in New Zealand or Australia to provide clear guidance on conducting DMC assessments. This systematised review aimed to examine the current processes, issues and debates within DMC assessments as detailed in Australasian literature. Six databases were searched: CINAHL, Scopus, Embase, Medline, PsycINFO and Google Scholar following PRISMA guidelines. A total of 33 articles were included in the review and, following a quality assessment, an inductive approach was used to determine key topics which were synthesised in the review. Five distinct issues were revealed, namely a lack of standardisation and guidelines in approaching DMC assessments, training and knowledge of DMC, professional roles, medical and psychiatric complexities and the medico-legal interface. [ABSTRACT FROM AUTHOR]

The Repeatable Battery for the Assessment of Neuropsychological Status (RBANS) Effort Index (EI) may be unreliable at its standard recommended cutoff score when used with forensic psychiatric inpatient populations given high rates of genuine cognitive impairment. The present study sought to (a) examine the rate of invalid performance on the RBANS EI using the standard cutoff among incompetent to stand trial (IST) inpatients and (b) investigate the psychometric properties of the RBANS EI at various cutoff scores. This study was conducted using archival assessment data collected at a large forensic psychiatric hospital. Across the entire sample (N = 238, 79% male, Mage = 45 years, 24% primary Spanish-speaking), 79% were diagnosed with a schizophrenia spectrum disorder. Experiment 1 of the study (n = 165) contained IST patients who were classified as having a valid presentation. Experiment 2 contained a valid (n = 46) and invalid (n = 27) presentation group comprised of postadjudication and IST inpatients, respectively. In Experiment 1, over one third (36.4%) of the valid presentation sample scored above the standard recommended EI cutoff. In Experiment 2, applying the standard recommended cutoff score of >3 was associated with a false positive rate of over 20%. Obtaining <10% false positive errors was achieved at a cutoff score of >5. At this cutoff score, the estimated local base rate of invalid responding among IST patients was 28%. Clinical and forensic implications and recommendations for adopting this more conservative RBANS EI cutoff score are discussed. Public Significance Statement: The current research suggests that individuals with schizophrenia spectrum disorders who reside in forensic hospital settings are at risk for being falsely identified as putting forth invalid performance on the Repeatable Battery for the Assessment of Neuropsychological Status Effort Index when using the standard recommended cutoff score, which may be related to high rates of genuine cognitive impairment. As such, an alternative Repeatable Battery for the Assessment of Neuropsychological Status Effort Index cutoff score is recommended when assessing individuals in these and similar settings. [ABSTRACT FROM AUTHOR]

Involuntary psychiatric holds, such as the 5150 hold in California, allow for an individual to be taken into custody for evaluation and treatment for up to 72 h when they present a risk of danger to themselves. 5150s and other coerced holds present a bioethical tension as patient autonomy is overridden to provide psychiatric care. I discuss two arguments that aim to provide ethical justifications for overriding patient autonomy during 5150 holds: the "clinical benefit" and "lack of capacity" arguments. By demonstrating that these arguments do not always hold, I argue that overriding patient autonomy during 5150 holds is not always ethical and can be harmful. Lastly, I make recommendations for the 5150 and similar involuntary psychiatric holds to minimize harmful breaches of patient dignity: creating consistent field guidelines for assessing prehospital capacity, educating prehospital providers about the potential harms of 5150s, and utilizing existing support structures within the social context of the patient when they have capacity to refuse further prehospital care. [ABSTRACT FROM AUTHOR]

Copyright of Dados - Revista de Ciências Sociais is the property of DADOS and its content may not be copied or emailed to multiple sites or posted to a listserv without the copyright holder's express written permission. However, users may print, download, or email articles for individual use. This abstract may be abridged. No warranty is given about the accuracy of the copy. Users should refer to the original published version of the material for the full abstract. (Copyright applies to all Abstracts.)

The study examines how two major strategy formulation approaches influence city governments' decision to collaborate. Collaboration with governmental and nongovernmental actors gives rise to varying levels of risks, which can be managed by using the appropriate strategy formulation approach. Using data from a national survey of cities, we find that formal strategic planning catalyzes cross-sectoral collaboration but is not associated with government-to-government collaboration. Logical incrementalism has a consistently negative relationship with collaboration regardless of sector. The findings indicate that collaboration can be limited by city governments' capacity to undertake formal strategic planning and their propensity to engage in incrementalist decision-making. [ABSTRACT FROM AUTHOR]

Human trafficking, the recruitment and transportation of persons by use of force, coercion, or deception for exploitation is one of the largest illicit industries worldwide. In the execution of anti-trafficking policies to combat this phenomenon, nation-states have assigned a decisive role to criminal justice actors as they are not only responsible for the detection, investigation, and prosecution of perpetrators but also for the identification and (legal) protection of victims of human trafficking. However, research has shown that criminal justice actors encounter many challenges whilst carrying out their tasks, which is also reflected in the low numbers of successful prosecutions and identified victims. To our knowledge, the reasons behind this observation have never been studied systematically. This systematic review aims to collect and synthesise empirical literature on factors that influence the criminal justice response to human trafficking to better understand and identify gaps in knowledge. In total, 35 empirical studies were included. Findings were discussed in light of theory and previous research and were used to provide recommendations for policy and future research. These studies suggest that factors such as prevailing stereotypes, an absence of legal guidance and a lack of capacity and expertise interact and even amplify each other and that strengthening the criminal justice response to human trafficking requires a multi-layered approach that simultaneously addresses several challenges. [ABSTRACT FROM AUTHOR]

This study investigates the roles of the socio-economic, land use, built environment, and weather factors in shaping up the demand for bicycle-sharing trips during the COVID-19 pandemic in Toronto. It uses "Bike Share Toronto" ridership data of 2019 and 2020 and a two-stage methodology. First, multilevel modelling is used to analyze how the factors affect monthly station-level trip generation during the pandemic compared to pre-pandemic period. Then, a geographically weighted regression analysis is performed to better understand how the relationships vary by communities and regions. The study results indicate that the demand of the service for commuting decreased, and the demand for recreational and maintenance trips increased significantly during the pandemic. In addition, higher-income neighborhoods are found to generate fewer weekday trips, whereas neighbourhoods with more immigrants experienced an increase in bike-share ridership during the pandemic. Moreover, the pandemic trip generation rates are more sensitive to the availability of bicycle facilities within station buffers than pre-pandemic rates. The results also suggest significant spatial heterogeneity in terms of the level of influence of the explanatory factors on the demand for bicycle-sharing during the pandemic. Based on the findings, some neighbourhood-specific policy recommendations are made, which inform decisions regarding the locations and capacity of new stations and the management of existing stations so that equity concerns about the usage of the system are adequately accounted for. [ABSTRACT FROM AUTHOR]

One of the key challenges in neuroscience is to generate the human nanoscale connectome which requires comprehensive knowledge of synaptome forming the neural microcircuits. The synaptic architecture determines limits of individual mental capacity and provides the framework for understanding neurologic disorders. Here, I address morphology modeling and storage estimation for the human synaptome at the nanoscale. A synapse is defined as a pair of pairs [(presynaptic_neuron),(presynaptic_axonal_terminal);(postsynaptic_neuron),(postsynaptic_dendritic_terminal)]. Center coordinates, radius, and identifier characterize a dendritic or axonal terminal. A synapse comprises topology with the paired neuron and terminal identifiers, location with terminal coordinates, and geometry with terminal radii. The storage required for the synaptome depends on the number of synapses and storage necessary for a single synapse determined by a synaptic model. I introduce three synaptic models: topologic with topology, point with topology and location, and geometric with topology, location, and geometry. To accommodate for a wide range of variations in the numbers of neurons and synapses reported in the literature, four cases of neurons (30;86;100;138 billion) and three cases of synapses per neuron (1,000;10,000;30,000) are considered with three full and simplified (to reduce storage) synaptic models resulting in total 72 cases of storage estimation. The full(simplified) synaptic model of the entire human brain requires from 0.21(0.14) petabytes (PB) to 28.98(18.63) PB for the topologic model, from 0.57(0.32) PB to 78.66(43.47) PB for the point model, and from 0.69(0.38) PB to 95.22(51.75) PB for the geometric model. The full(simplified) synaptic model of the cortex needs from 86.80(55.80) TB to 2.60(1.67) PB for the topologic model, from 235.60(130.02) TB to 7.07(3.91) PB for the point model, and from 285.20(155.00) TB to 8.56(4.65) PB for the geometric model. The topologic model is sufficient to compute the connectome's topology, but it is still too big to be stored on today's top supercomputers related to neuroscience. Frontier, the world's most powerful supercomputer for 86 billion neurons can handle the nanoscale synaptome in the range of 1,000–10,000 synapses per neuron. To my best knowledge, this is the first big data work attempting to provide storage estimation for the human nanoscale synaptome. [ABSTRACT FROM AUTHOR]

Aim: The main purpose of the present study was to validate the Slovenian version of the 41-item Capacity to Love Inventory (CTL-I). Based on psychoanalytic theory, limitations to capacity to love are expected to be associated with personality dysfunction and disintegration as well as fundamental mental capacities such as self-reflection and self-awareness. Method: To examine these assumptions, a sample of 552 Slovenian non-clinical individuals were recruited through academic networks. The construct validity of the CTL-I was assessed using a confirmatory factor analysis and convergent validity of the CTL-I and its subscales was established against IPO-16, PID-5 BF, MAAS. Results: Our findings show that the Slovenian version of the CTL-I replicated the six-factor structure, exhibiting good model fit as well as satisfactory internal consistency of all subscales. In line with expectations, capacity to love was found to be inversely associated with dysfunctional personality traits and structural personality disturbances. Accordingly, higher dispositional mindfulness was coherently associated with all domains of CTL-I. Conclusion: The results add to the growing evidence for the cross-cultural validity and sound psychometric properties of CTL-I, presented here in the Slovenian version. Our findings also point to the significance of dispositional mindfulness both in relation to capacity to love as well as mental health. [ABSTRACT FROM AUTHOR]

Fecal Microbiota Transplantation (FMT) has shown to possess impressive potential benefit for a wide range of clinical indications. Due to its inherent safety issues and efficacy constraints, the use of personalized FMT analogs could be a promising avenue. The development of such analogs will require a detailed understanding of their functionality, encompassing not only microbe-host interactions of the microbial taxa that are involved, but also of the ecological dimensions of the analogs and an overview of the gastrointestinal sites where these relevant microbial interactions take place. Moreover, characterization of taxa that have been lost due to diminished exposure to beneficial microbes, as a consequence of Western lifestyle, may lead to creation of future FMT analogs with the capacity to restore functionalities that we have lost. [ABSTRACT FROM AUTHOR]

Background: Young-onset AD (YOAD) typically occurs before the age of 65 and affects less than 6% of all people diagnosed with AD. There is a lack of research on differences between decision-making capacity and awareness according to age at onset of dementia. Objective: We investigated the relationship between decision-making capacity and awareness domains in people with young- (YOAD) and late-onset Alzheimer's disease (LOAD). Methods: A cross-sectional study included 169 consecutively selected people with AD and their caregivers (124 people with LOAD and 45 people with YOAD). Results: People with YOAD were more cognitively impaired, but more aware of their cognitive deficits and health condition, with moderate effect sizes. All people with AD presented deficits in the domains of decision-making capacity, with more impairment in understanding. There was a relationship between understanding and awareness domains, such that awareness was particularly important for decision-making capacity in the YOAD group. Conclusions: Better awareness involved better understanding in the YOAD group. Clinically, our findings shed light on the need to consider the differences in the domains of awareness and their relationship with other clinical aspects such as decision-making capacity according to age at onset of AD. Furthermore, our data can suggest hypotheses for larger and more robust prospective studies. [ABSTRACT FROM AUTHOR]

According to the World Health Organization (WHO), 5% of people around the world have hearing disabilities, which limits their capacity to communicate with others. Recently, scientists have proposed systems based on deep learning techniques to create a sign language-to-text translator, expecting this to help deaf people communicate; however, the performance of such systems is still low for practical scenarios. Furthermore, the proposed systems are language-oriented, which leads to particular problems related to the signs for each language. For this reason, to address this problem, in this paper, we propose a system based on a Recursive Neural Network (RNN) focused on Mexican Sign Language (MSL) that uses the spatial tracking of hands and facial expressions to predict the word that a person intends to communicate. To achieve this, we trained four RNN-based models using a dataset of 600 clips that were 30 s long; each word included 30 clips. We conducted two experiments; we tailored the first experiment to determine the most well-suited model for the target application and measure the accuracy of the resulting system in offline mode; in the second experiment, we measured the accuracy of the system in online mode. We assessed the system's performance using the following metrics: the precision, recall, F1-score, and the number of errors during online scenarios, and the results computed indicate an accuracy of 0.93 in the offline mode and a higher performance for the online operating mode compared to previously proposed approaches. These results underscore the potential of the proposed scheme in scenarios such as teaching, learning, commercial transactions, and daily communications among deaf and non-deaf people. [ABSTRACT FROM AUTHOR]

AbstractI review the virtues and limitations of the narrative paradigm in contemporary clinical practice. I contrast ‘episodic’ and ‘diachronic’ forms of life, the former characterised by no particular predisposition to see one’s life in narrative terms and the tendency to experience oneself fragmentarily. After highlighting a progressive decline of storytelling in the current socio-cultural scenario, I show how a number of conditions (borderline-type personality and identity development in adolescence) are marked by reduced ability to organise narratively one’s own experiences. I emphasize a mismatch between the episodic and fragmentary phenomena characterizing these conditions and the prevailing opinion among clinicians belonging to academic culture that values instead the narrative paradigm. In the training of the clinicians, in addition to the necessary skills related to the diagnostic framing of the patient’s symptoms, and in addition to narrative competence, the capacity to embrace all that is fragmentary (that is, what at face value escapes diagnosis and narration) is necessary. I corroborate the approach with a theory taken from contemporary art criticism called ‘aesthetics of post-production’ and its capacity to re-signify the meaning of fragments by recontextualizing them. The personal ‘knots’ in the patient’s experience can be preserved and enhanced only through fragment-oriented listening. [ABSTRACT FROM AUTHOR]

The integration of artificial intelligence (AI) in cardiovascular imaging has revolutionized the field, offering significant advancements in diagnostic accuracy and clinical efficiency. However, the complexity and opacity of AI models, particularly those involving machine learning (ML) and deep learning (DL), raise critical legal and ethical concerns due to their "black box" nature. This manuscript addresses these concerns by providing a comprehensive review of AI technologies in cardiovascular imaging, focusing on the challenges and implications of the black box phenomenon. We begin by outlining the foundational concepts of AI, including ML and DL, and their applications in cardiovascular imaging. The manuscript delves into the "black box" issue, highlighting the difficulty in understanding and explaining AI decision-making processes. This lack of transparency poses significant challenges for clinical acceptance and ethical deployment. The discussion then extends to the legal and ethical implications of AI's opacity. The need for explicable AI systems is underscored, with an emphasis on the ethical principles of beneficence and non-maleficence. The manuscript explores potential solutions such as explainable AI (XAI) techniques, which aim to provide insights into AI decision-making without sacrificing performance. Moreover, the impact of AI explainability on clinical decision-making and patient outcomes is examined. The manuscript argues for the development of hybrid models that combine interpretability with the advanced capabilities of black box systems. It also advocates for enhanced education and training programs for healthcare professionals to equip them with the necessary skills to utilize AI effectively. Patient involvement and informed consent are identified as critical components for the ethical deployment of AI in healthcare. Strategies for improving patient understanding and engagement with AI technologies are discussed, emphasizing the importance of transparent communication and education. Finally, the manuscript calls for the establishment of standardized regulatory frameworks and policies to address the unique challenges posed by AI in healthcare. By fostering interdisciplinary collaboration and continuous monitoring, the medical community can ensure the responsible integration of AI into cardiovascular imaging, ultimately enhancing patient care and clinical outcomes. [ABSTRACT FROM AUTHOR]

Canada has committed to establishing a socially equitable, environmentally sustainable and economically viable blue economy but has not yet determined a sustainability standard that industry must meet to be included in this aspirational blue economy. For the blue economy to be an effective, sustainable alternative to the regular ocean economy, clear criteria for ocean business must be established to reduce the risk of blue washing. The UN Sustainable Development Goals (SDGs) provide an ideal theoretical basis from which to develop a marine sector standard for blue economy industry. Using a criteria-based approach, this work selected relevant SDG targets that can guide Canada's ocean industry in the transition to a blue economy. Through a stepwise process, the selected targets were further contextualized to the company level resulting in a blue economy capacity assessment framework (BECF) that offers four blue economy industry aims and associated enabling mechanisms. The BECF practically links the theory of the SDGs to a desired outcome, providing a method for an ocean-based company to assess its contribution to all three dimensions of Canada's blue economy. [ABSTRACT FROM AUTHOR]

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IntroductionMaterials and methodsResultsDiscussionThe first aim of this study was to explore the mental functions of patients with mild intellectual disabilities or borderline intellectual functioning (MID-BIF) in mental health care. The second aim was to examine the differences in mental functions between people with MID-BIF and those with higher educational levels (i.e. further education [FE] and higher education [HE]).Eleven mental functions were assessed using the Shedler-Westen Assessment Procedure (SWAP-200-NL). In total, 245 patients were included, divided into three groups (MID-BIF: N = 52; FE: N = 86; HE: N = 107).Results showed that the MID-BIF group scored relatively high on three mental functions (i.e. the capacity for impulse control and regulation, capacity for defensive functioning, and capacity to construct and use internal standards and ideals). One mental function scored relatively low (the capacity for adaptation, resiliency, and strength). Regarding group comparisons, similar patterns in average scores emerged, and the HE group scored higher than the MID-BIF and the FE groups on most mental functions.The mental functions of the HE group were most adaptive, whereas the mental functions of the FE and MID-BIF groups were less adaptive and on a similar level in each of these groups. [ABSTRACT FROM AUTHOR]

To ensure the accuracy of radiation delivery to patients in a 1.5 T MRI-linac, the implementation of quality assurance (QA) devices compatible with MR technology is essential. The OCTAVIUS 4D MR, made by PTW (Freiburg, Germany) is designed to ensure consistent and ideal alignment of its detectors with the direction of each beam segment. This study focuses on investigating the fundamental characteristics of the detector response for the OCTAVIUS Detector (OD) 1500 MR and OCTAVIUS 1600 MR when used in the MR-compatible OCTAVIUS 4D. Characteristics examined included short-term reproducibility, dose linearity, field size dependency, monitor unit (MU) rate dependency, dose-per-pulse dependency, and angular dependency. The evaluation of OD 1500 MR also involved measuring 25 clinical treatment plans across diverse target sizes and anatomical sites, including the liver/pancreas, rectum, prostate, lungs, and lymph nodes. One plan was measured with the standard setup and with a 5 cm left offset. The OD 1600 MR was not available for these measurements. The capability of the OD 1500 MR to identify potential errors was assessed by introducing a MU and positional shift within the software. The results demonstrated no significant differences in short-term reproducibility ( < 0.2 % ), dose linearity ( < 1 % ), field size dependency ( < 0.7 % for field sizes larger than 5 cm × 5 cm), MU rate dependency ( < 0.8 % ), dose-per-pulse dependency ( < 0.4 % ) and angular dependency (standard deviation < 0.5 % ). All tests of clinical plans were successfully completed. The OD 1500 MR demonstrated compatibility with the standard 95% pass rate when employing a global 3%/3 mm gamma criterion, and a 90% pass rate using a global 2%/2 mm gamma criterion. The detector demonstrated the capacity to measure treatment plans with a 5 cm left offset. With the standard parameters, the gamma test was sensitive to position errors but required an addition tests of mean/median dose or point dose in order to detect small dose difference. [ABSTRACT FROM AUTHOR]

AbstractPurposeMaterials and MethodsResultsConclusions\nIMPLICATIONS FOR REHABILITATIONDisability experts are often called upon to analyze the economic impact of an injury. Determining future economic loss in cases of disabilities is difficult, particularly when the disabilities are considered partial in nature, and the individuals have some capacity to mitigate their future income losses. This paper examines one possible approach for examining reduced future income capacity in cases of partial disabilities, the use of the Work Ability Index (WAI) and Work Ability Scale (WAS).Empirical data from one-hundred six cases is analyzed using a censored tobit regression to determine the relationship between scores on the WAI/WAS and verified long-term income losses for individuals who suffered disabling events.The study found a high correlation between the scores obtained on both the WAI and WAS measures, and future economic loss. The results suggest that these scales may be very useful in analyzing reduced future income capacity in situations involving partial disabilities.This study assists the rehabilitation and disability expert to better understand the implications of a moderate to severe disability on the future income capacity of an injured person. It also provides additional support for the validity of the WAI/WAS scales.The Workability Scale is a valid measure to examine the effectiveness of rehabilitation programsThe Workability Scale is a good proxy to determine the loss of earnings capacity in cases of moderate to severe partial disability casesThe Workability Scale can be used as a simple cross-check for more complex methods that vocational/occupational experts use for purposes of determining earnings capacity losses.The Workability Scale is a valid measure to examine the effectiveness of rehabilitation programsThe Workability Scale is a good proxy to determine the loss of earnings capacity in cases of moderate to severe partial disability casesThe Workability Scale can be used as a simple cross-check for more complex methods that vocational/occupational experts use for purposes of determining earnings capacity losses. [ABSTRACT FROM AUTHOR]

While there is increasing use of standardised tools to assist in determining decision-making capacity in adults, there is limited literature evaluating these tools in children/adolescents. The current PRISMA guided systematic review aimed to evaluate standardised capacity assessment tools used in the child/adolescent population, and to examine the relationship between these capacity assessment tools and cognition. Inclusion criteria comprised: (1) validation of a new/existing tool to assess capacity or competence; (2) participants < 18 years; (3) involved validation on normative or non-normative populations; (4) published in English in a peer review journal. Ten studies were included. The majority applied a version of the Macarthur Competence Assessment Tool. Findings suggest capacity assessment tools demonstrate sound psychometric properties, but research into capacity assessment in children is still in its infancy. Limitations include the lack of diagnostic gold standard of capacity and the inconsistent and minimal incorporation of cognitive functioning into standardised capacity assessment. [ABSTRACT FROM AUTHOR]

The rationale for the use of metformin as a treatment to slow aging was largely based on data collected from metabolically unhealthy individuals. For healthspan extension metformin will also be used in periods of good health. To understand the potential context specificity of metformin treatment on skeletal muscle, we used a rat model (high‐capacity runner/low‐capacity runner [HCR/LCR]) with a divide in intrinsic aerobic capacity. Outcomes of metformin treatment differed based on baseline intrinsic mitochondrial function, oxidative capacity of the muscle (gastroc vs soleus), and the mitochondrial population (intermyofibrillar vs. subsarcolemmal). Metformin caused lower ADP‐stimulated respiration in LCRs, with less of a change in HCRs. However, a washout of metformin resulted in an unexpected doubling of respiratory capacity in HCRs. These improvements in respiratory capacity were accompanied by mitochondrial remodeling that included increases in protein synthesis and changes in morphology. Our findings raise questions about whether the positive findings of metformin treatment are broadly applicable. [ABSTRACT FROM AUTHOR]

The effect of 7‐day subfreezing storage on the physicochemical properties, nutritional composition, and microstructure of pork was investigated. After 7 days of chilling at 4°C, the meat exhibited color deterioration and the development of off‐flavors. In contrast, the −12°C treatment significantly reduced the deterioration in water‐holding capacity and color of samples (p < 0.05) and prevented changes in pH value. Similarly, the treatments at −12 and −18°C effectively preserved the meat's tenderness, thiobarbituric acid‐reactive substances, protein solubility, and textural properties, maintaining these qualities close to those of fresh meat (p > 0.05). The nutrient content of samples stored at −12°C was comparable to those stored at −18°C (p > 0.05). Furthermore, subfreezing at −12°C was found to protect muscle integrity, promoting the formation of an elastic gel network and a homogenous muscle fiber structure. Therefore, the study concludes that 7‐day subfreezing storage at −12°C can reduce protein denaturation and maintain thequality of pork, a result that is typically achieved under more extreme freezing conditions at −18°C. [ABSTRACT FROM AUTHOR]

The Preamble of the Constitution of Cameroon Indent 17 affirms the Nation's aim to protect and promote the family which is the natural foundation of human society as well as protecting women and the young. Families generally start with marriage. Protecting the family therefore implies protecting marriage which goes by setting rules for its validity and maintenance. For a marriage to be valid, parties must fulfil formalities and have capacity. Capacity to marry determines whether an individual may legally be entitled to get married or not. The minimum age for marriage is a key component of capacity to marry as no marriage is valid if contracted under that age. This stems from the fact that age determines other criteria such as the capacity to give valid consent and to comprehend marriage's commitments. Setting the minimum age for marriage is a requirement enshrined in all relevant international human rights instruments ratified by Cameroon. The question is as to whether Cameroon's domestic law on marriage complies with international standards. In order to tackle that question, the exegetic method has been used to extract the contents of the relevant international and national instruments, analyse and interpret them in order to determine whether and, if so, to what extent the Cameroonian law on marriage complies with international standards relating to the minimum age for marriage. It is found out that while Cameroonian law complies with some aspects of international standards, it is still lacking in others and that, the only solution is to amend the existing law so that it may fully comply with international precepts. [ABSTRACT FROM AUTHOR]

The war on Ukraine is the most severe security crisis that Europe, and the European Union (EU), has faced since World War II. Contrary to what many expected, the EU responded quickly and comprehensively to the Russian invasion. How, if in any way, does the EU's response to the war on Ukraine suggest that the EU is coming of age in the foreign and security domain? By exploring EU policies and actions across three key maturation processes, our analysis finds that the EU has become a more mature foreign policy actor, in a process that started well before the Russian full scale invasion but has escalated since then. With its broad response to the war on Ukraine, the EU has shown an increased ability to take quick decisions, provide resources and combine various instruments in response to a crisis (increased decision-making ability); it is taking on a clearer foreign policy role/identity as a principled pragmatist and crisis manager (more stable identity status); and this plays out in its relations with the US, in NATO and bilaterally (more salient and defined relations). [ABSTRACT FROM AUTHOR]

A complex network of ethico‐legal rules makes it difficult for health researchers in South Africa to lawfully recruit adolescents to the kinds of sensitive studies where it may be ethically appropriate to proceed without notifying parents or obtaining parental consent. This article responds to a recent proposal to amend the blanket requirement for mandatory parental consent presently contained in section 71 the South African National Health Act 61 of 2003 [NHA]. The proposed amendment is intended to bring the NHA into alignment with South Africa's 2015 Department of Health Guidelines on Ethics in Health Research by permitting greater flexibility for a health research ethics committee to waive parental consent, and permit adolescents to consent independently. A lacuna in this proposal is highlighted with reference to the requirements of South Africa's Protection of Personal Information Act 4 of 2013 [POPIA]: Even if the NHA is amended as proposed, the goal of aligning South African law with prevailing ethics norms in South Africa would not necessarily be attained, as parental consent may still be required by POPIA. This article investigates whether this goal (of aligning the law with ethics) can be attained in a way that is compliant with POPIA. It is concluded that this is indeed possible in a number of ways, and that the best way to attain this goal is by requesting the South African Information Regulator to issue a guidance note to the effect that all health research projects that are approved by institutional health research ethics committees are to be regarded as being in the public interest, which would qualify such health research projects to be exempted from POPIA's consent requirements. [ABSTRACT FROM AUTHOR]

Background: Measurement instruments to understand self‐determined motivation towards physical activity among college students with intellectual disabilities are needed to develop programs to support physical and psychological health and well‐being. The purpose of the current study was to validate a modified questionnaire measuring basic psychological needs towards physical activity among college students with intellectual disabilities. Methods: A total of 108 college students with intellectual disabilities completed the modified questionnaire. Validity and reliability of the questionnaire was examined. Results: Confirmatory factor analysis demonstrated a six‐factor model had good model fit. Cronbach's alpha values showed acceptable reliability evidence of the instrument as a whole, although some alpha values in subdomains of the instrument were below acceptable values. Conclusion: The modified questionnaire was found to have acceptable validity evidence. Further studies are needed with refinement of answer options and the addition of more questions to increase reliability. [ABSTRACT FROM AUTHOR]

Summary: Alpha‐lactalbumin (α‐LA) is one of the allergens in cow's milk. Glycation modifications can be used to modulate the allergenicity of α‐LA and to clarify the effects of glycation of three reducing sugars (D‐fructose, D‐ribose, and D‐xylose) on the structure and immunoglobulin G (IgG)‐binding capacity of α‐LA. In this study, the colorimetric and spectroscopic methods reflect the degree of glycation. The structural properties of the glycation products were characterised using spectroscopic and chromatographic methods. The IgG‐binding capacity was determined by an indirect competitive enzyme‐linked immunosorbent assay. The results showed a decrease in free amino groups content, an increase in molecular weight. The α‐helix content was reduced, but the β‐sheet and irregular coil content increased, resulting in a more loosened protein structure. All three reducing sugar glycation products had higher IgG‐binding capacity, suggesting that glycation has the potential to enhance α‐LA allergenicity. This study provides different perspectives on the allergenicity of cow's milk allergens modified by different sugar glycations. [ABSTRACT FROM AUTHOR]