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Fusion energy has the potential to address long-term energy requirements and climate change. However, fusion energy is characterized by a “development divide” between the International Thermonuclear Experimental Reactor (ITER) consortium members and the non-ITER “Global South” states. It is beset with problems, which can be divided into geopolitical, geo-economic, geo-sociocultural, and geo-technological (GEO-PEST). Geopolitical problems include cooperation on fusion energy development between ITER members (of the Global North) and the Global South on fusion development. Geo-economic problems include the cost of funding ITER versus newly emerging private-sector fusion companies. Geo-sociocultural problems include the requirement to maintain the peacebuilding tradition of nuclear energy (embodied by the Cold War-era “Atoms for Peace” initiative), as well as public perceptions of radiation. Geo-technological problems include tokamak lock-in, fuel type, the viability of “compact reactors,” and disruptive technology events. In this article, we outline these problems and discuss how to address them in a timely fashion via an external independent review mechanism, modeled on the International Energy Agency's “Global Commission for Urgent Action on Energy Efficiency,” established in 2019 and due to deliver recommendations in 2020.

Since the end of its absolute monarchy in 1932, Thailand has been variously described as a “hybrid regime,” “flawed democracy,” and “failed democracy.” Furthermore, its governance system has been identified as “electoral authoritarianism,” ‘hybrid authoritarianism,” “military domination,” and “Thai-style democracy.” Regardless of the analytic lens applied, the history of Thai politics has involved a continuing struggle for control of government between both authoritarian and democratic forces. Following the 2014 military coup d’état, the first election held in 2019 saw the 2014 military coup leader, General Prayuth Chan-o-cha, elected as prime minister. This article assesses the conduct and results of the 2019 election in terms of the general discourse on electoral authoritarianism and as an emerging framing of authoritarian regimes particularly applicable to Southeast Asia—the rise of “sophisticated authoritarianism.” This approach distills and integrates the discourse on electoral authoritarianism to produce a typology that is useful for considering the empirical characteristics of Southeast Asia. The 2019 election offers an opportunity to consider Thailand within this framing and to determine to what extent the military-dominated regime and its holistic manipulation of electoral institutions and processes can be assessed as “sophisticated authoritarianism.” This study demonstrates that Prayuth's election partially demonstrates “sophisticated authoritarianism”; nonetheless, his attempt to depoliticise Thailand and reduce it to a non-political state has met substantial resistance that will likely persist while he remains in power.

Objective: This randomized, prospective, blinded study compared pain in children following dental treatment under general anesthesia (GA) using 1 of 2 established analgesia methods. Methods: Patients age 4 to 7 years were randomly assigned to a control group (intravenous [IV] analgesics) or experimental group (IV analgesics and intrapapillary local anesthetic infiltrations) between July 2017 and February 2018. During recovery from surgery, Faces, Legs, Activity, Cry, and Consolability (FLACC) scores were recorded upon regaining consciousness and reassessed every 15 minutes until discharge. Overall pain occurrence (FLACC ≥1) and moderate/severe pain occurrence (FLACC ≥4) were analyzed using mixed effects logistic regression (N = 88). Results: The experimental group had a 17% lower overall pain occurrence than the control group (16 vs 33%; p = .02). Moderate/severe pain occurrence between the groups was not significant (9 vs 22%; p = .23). The dental treatment subjects received (number of completed stainless steel crowns, extractions, and/or pulpotomies) did not significantly affect pain occurrence. Conclusion: Local anesthesia intrapapillary infiltrations around stainless steel crowns decrease overall pain occurrence but not moderate/severe pain occurrence following dental treatment under GA in pediatric patients.

Introduction Unhealthy lifestyles are major factors contributing to chronic conditions. By proposing suitable menu designs and easy recipes, Open Food Service internet app with connected food processors will bring easy solutions to cook and progressively develop healthy dietary habits at home. A randomized controlled trial will test in healthy subjects the ability of connected food processors to modify dietary habits and to improve metabolic homeostasis, assessed with a systems health monitoring, all at home. Methodology and analysis This is a prospective, randomized, single blind and 12 month controlled trial in Grenoble and Aberystwyth. Double consent using Zelen method of randomization is used. Healthy volunteers, 25–50 years old, living in a family, be the main person who prepares meals and be able to use the personal health monitoring devices are recruited, 100 in Grenoble and 60 in Aberystwyth. The principal objective is to evaluate the ability of connected cook devices to modify dietary habits measured by a clinically significant increase of 1 quintile in Alternate Healthy Eating Index-2010. Secondary objectives are a) to demonstrate feasibility to collect data and specimen at home over one year; b) to compare changes at one year in quality of life, body composition, physical activities, sleep duration, gut microbiote; c) to describe urinary metabolomics patterns that are able to report recent dietary habits. Elementary descriptive analysis and integration of all data sets vertically and longitudinally and comparisons between groups will be carried out. The two two studies are conducted separately and analysed in meta-analysis.

Objective: Specific content characteristics of suicide media reporting might differentially impact suicides in the population, but studies have not considered the overarching theme of the respective media stories and other relevant outcomes besides suicide, such as help-seeking behaviours. Methods: We obtained 5652 media reports related to suicide from 6 print, 44 broadcast and 251 online sources in Oregon and Washington states, published between April 2019 and March 2020. We conducted a content analysis of stories regarding their overarching focus and specific content characteristics based on media recommendations for suicide reporting. We applied logistic regression analyses to assess how focus and content characteristics were associated with subsequent calls to the US National Suicide Prevention Lifeline (Lifeline) and suicides in these two states in the week after publication compared to a control time period. Results: Compared to a focus on suicide death, a focus on suicidal ideation, suicide prevention, healing stories, community suicide crises/suicide clusters and homicide suicide was associated with more calls. As compared to a focus on suicide death, stories on suicide prevention and stories on community suicide crises/suicide clusters were also associated with no increase in suicides. Regarding specific content characteristics, there were associations that were largely consistent with previous work in the area, for example, an association of celebrity suicide reporting with increases in suicide. Conclusion: The overall focus of a media story may influence help-seeking and suicides, and several story characteristics appear to be related to both outcomes. More research is needed to investigate possible causal effects and pathways.

Objective: The aim of this study was to assess associations of various content areas of Twitter posts with help-seeking from the US National Suicide Prevention Lifeline (Lifeline) and with suicides. Methods: We retrieved 7,150,610 suicide-related tweets geolocated to the United States and posted between 1 January 2016 and 31 December 2018. Using a specially devised machine-learning approach, we categorized posts into content about prevention, suicide awareness, personal suicidal ideation without coping, personal coping and recovery, suicide cases and other. We then applied seasonal autoregressive integrated moving average analyses to assess associations of tweet categories with daily calls to the US National Suicide Prevention Lifeline (Lifeline) and suicides on the same day. We hypothesized that coping-related and prevention-related tweets are associated with greater help-seeking and potentially fewer suicides. Results: The percentage of posts per category was 15.4% (standard deviation: 7.6%) for awareness, 13.8% (standard deviation: 9.4%) for prevention, 12.3% (standard deviation: 9.1%) for suicide cases, 2.4% (standard deviation: 2.1%) for suicidal ideation without coping and 0.8% (standard deviation: 1.7%) for coping posts. Tweets about prevention were positively associated with Lifeline calls ( B = 1.94, SE = 0.73, p = 0.008) and negatively associated with suicides ( B = −0.11, standard error = 0.05, p = 0.038). Total number of tweets were negatively associated with calls ( B = −0.01, standard error = 0.0003, p = 0.007) and positively associated with suicide, ( B = 6.4 × 10−5, standard error = 2.6 × 10−5, p = 0.015). Conclusion: This is the first large-scale study to suggest that daily volume of specific suicide-prevention-related social media content on Twitter corresponds to higher daily levels of help-seeking behaviour and lower daily number of suicide deaths. Preregistration: As Predicted, #66922, 26 May 2021.

Sedation and general anesthesia are necessities for the treatment of many individuals within special populations such as those with physical and intellectual disabilities, fear/anxiety, or individuals requiring extensive procedures. This study aims to discover regulatory factors that may be contributing to the limited access to anesthesia services provided by dentist anesthesiologists.The study included an online survey completed by self-reported dentist anesthesiologists with 2 or more years of formal anesthesia training. The survey was distributed at the April 2019 American Society of Dentist Anesthesiologists national meeting in Chicago. Participants responded to questions regarding the effect of specific state regulations on decisions to practice in a particular state and how such regulations influenced patient safety and barriers to care. Rules and regulatory restrictions on the mobility of dentist anesthesiologist equipment/supplies and additional state narcotic transportation regulations were deemed statistically significant in failing to improve safety. Requiring airway and sedation training for a facility's provider and staff were not barriers to care. Rules and regulations were not a factor to establishing clinical practice in one state over another state.Individuals and organizations responsible for influencing the regulatory environment of anesthesia services should improve regulations to facilitate the mobility of dentist anesthesiologists.

Introduction Flow infusion electrospray high resolution mass spectrometry (FIE-HRMS) fingerprinting produces complex, high dimensional data sets which require specialist in-silico software tools to process the data prior to analysis. Objectives Present spectral binning as a pragmatic approach to post-acquisition procession of FIE-HRMS metabolome fingerprinting data. Methods A spectral binning approach was developed that included the elimination of single scan m/z events, the binning of spectra and the averaging of spectra across the infusion profile. The modal accurate m/z was then extracted for each bin. This approach was assessed using four different biological matrices and a mix of 31 known chemical standards analysed by FIE-HRMS using an Exactive Orbitrap. Bin purity and centrality metrics were developed to objectively assess the distribution and position of accurate m/z within an individual bin respectively. Results The optimal spectral binning width was found to be 0.01 amu. 80.8% of the extracted accurate m/z matched to predicted ionisation products of the chemical standards mix were found to have an error of below 3 ppm. The open-source R package binneR was developed as a user friendly implementation of the approach. This was able to process 100 data files using 4 Central Processing Units (CPU) workers in only 55 seconds with a maximum memory usage of 1.36 GB. Conclusion Spectral binning is a fast and robust method for the post-acquisition processing of FIE-HRMS data. The open-source R package binneR allows users to efficiently process data from FIE-HRMS experiments with the resources available on a standard desktop computer.

Objective: Digital monitoring technologies (e.g., smart-phones and wearable devices) provide unprecedented opportunities to study potentially harmful behaviors such as suicide, violence, and alcohol/substance use in real-time. The use of these new technologies has the potential to significantly advance the understanding, prediction, and prevention of these behaviors. However, such technologies also introduce myriad ethical and safety concerns, such as deciding when and how to intervene if a participant’s responses indicate elevated risk during the study? Methods: We used a modified Delphi process to develop a consensus among a diverse panel of experts on the ethical and safety practices for conducting digital monitoring studies with those at risk for suicide and related behaviors. Twenty-four experts including scientists, clinicians, ethicists, legal experts, and those with lived experience provided input into an iterative, multi-stage survey, and discussion process. Results: Consensus was reached on multiple aspects of such studies, including: inclusion criteria, informed consent elements, technical and safety procedures, data review practices during the study, responding to various levels of participant risk in real-time, and data and safety monitoring. Conclusions: This consensus statement provides guidance for researchers, funding agencies, and institutional review boards regarding expert views on current best practices for conducting digital monitoring studies with those at risk for suicide—with relevance to the study of a range of other potentially harmful behaviors (e.g., alcohol/substance use and violence). This statement also highlights areas in which more data are needed before consensus can be reached regarding best ethical and safety practices for digital monitoring studies.

Because of the pervasiveness, persistence, and toxicity of per- and polyfluoroalkyl substances (PFAS), there is growing concern over PFAS contamination, exposures, and health effects. The diversity of potential PFAS is astounding, with nearly 10,000 PFAS catalogued in databases to date (and growing). The ability to detect the thousands of known PFAS, and discover previously uncatalogued PFAS, is necessary to understand the scope of PFAS contamination and to identify appropriate remediation and regulatory solutions. Current non-targeted methods for PFAS analysis require manual curation and are time-consuming, prone to error, and not comprehensive. FluoroMatch Flow 2.0 is the first software to cover all steps of data processing for PFAS discovery in liquid chromatography–high-resolution tandem mass spectrometry samples. These steps include feature detection, feature blank filtering, exact mass matching to catalogued PFAS, mass defect filtering, homologous series detection, retention time pattern analysis, class-based MS/MS screening, fragment screening, and predicted MS/MS from SMILES structures. In addition, a comprehensive confidence level criterion is implemented to help users understand annotation certainty and integrate various layers of evidence to reduce overreporting. Applying the software to aqueous film forming foam analysis, we discovered over one thousand likely PFAS including previously unreported species. Furthermore, we were able to filter out 96% of features which were likely not PFAS. FluoroMatch Flow 2 increased coverage of likely PFAS by over tenfold compared to the previous release. This software will enable researchers to better characterize PFAS in the environment and in biological systems.

naturally acquired blood-stage malaria antibodies and malaria clinical data have been reported to be useful in monitoring malaria change over time and as a marker of malaria exposure. This study assessed the total immunoglobulin G (IgG) levels to Plasmodium falciparum schizont among infants (5-17 months), estimated malaria incidence using routine health facility-based surveillance data and predicted trend relation between anti-schizont antibodies and malaria incidence in Bagamoyo.252 serum samples were used for assessment of total IgG by enzyme-linked immunosorbent assay and results were expressed in arbitrary units (AU). 147/252 samples were collected in 2021 during a blood-stage malaria vaccine trial [ClinicalTrials.gov NCT04318002], and 105/252 were archived samples of malaria vaccine trial conducted in 2012 [ClinicalTrials.gov NCT00866619]. Malaria incidence was calculated from outpatient clinic data of malaria rapid test or blood smear positive results retrieved from District-Health-Information-Software-2 (DHIS2) between 2013 and 2020. Cross-sectional data from both studies were analysed using STATA version 14.this study demonstrated a decline in total anti-schizont IgG levels from 490.21AU in 2012 to 97.07AU in 2021 which was related to a fall in incidence from 58.25 cases/1000 person-year in 2013 to 14.28 cases/1000 person-year in 2020. We also observed a significant difference in incidence when comparing high and low malaria transmission areas and by gender. However, we did not observe differences when comparing total anti-schizont antibodies by gender and study year.total anti-schizont antibody levels appear to be an important serological marker of exposure for assessing the dynamic of malaria transmission in infants living in malaria-endemic regions.

The smart city movement (SCM) is spreading globally with increasing velocity. With its international allure, it has generated a burgeoning body of international literature, much of which forms what...

This article provides a high-level review of the geopolitical status quo of nuclear fusion energy and outlines a vision for the future against the backdrop of Industry 5.0 and Society 5.0. In 2020, the year of the 75th anniversary of Hiroshima and Nagasaki, ITER, the world’s largest fusion experiment, began its machine assembly, and next year, the DEMO (fusion power) stage of ITER planning is formally due to begin. With several countries now engaged in the design of DEMO-phase machines, we stress that a “burning plasma” self-sustaining fusion reaction event will be a critical juncture similar in status to the Trinity Test. In response, urging the need for US geopolitical engagement, we call for a “Global Commission for Urgent Action on Fusion Energy,” to be backed by the International Atomic Energy Agency and International Energy Agency (IEA), along the lines of the existing IEA “Global Commission for Urgent Action on Energy Efficiency.” We see the Commission serving a similar, this time international, role to the 1946 “Acheson-Lilienthal” report for fission and involving a global External Independent Review of the state-of-the art of fusion energy technologies. We suggest major “soft power” co-chairs from the Global West and North and from the Global South, thereby providing a geopolitical pivot which can unlock tens of billions of dollars in funding for multiple technology pathways, create a global regime to safeguard Intellectual Property, accelerate the transition from fossil fuels to a “Future Fusion Economy,” and prevent the geopolitical polarization of fusion energy.

Habitual consumption of poor quality diets is linked directly to risk factors for many non-communicable diseases. This has resulted in the vast majority of countries and the World Health Organization developing policies for healthy eating to reduce the prevalence of non-communicable diseases in the population. However, there is mounting evidence of variability in individual metabolic responses to any dietary intervention. We have developed a method for applying a pipeline for understanding interindividual differences in response to diet, based on coupling data from highly controlled dietary studies with deep metabolic phenotyping. In this feasibility study, we create an individual Dietary Metabotype Score (DMS) that embodies interindividual variability in dietary response and captures consequent dynamic changes in concentrations of urinary metabolites. We find an inverse relationship between the DMS and blood glucose concentration. There is also a relationship between the DMS and urinary metabolic energy loss. Furthermore, we use a metabolic entropy approach to visualize individual and collective responses to dietary interventions. Potentially, the DMS offers a method to target and to enhance dietary response at the individual level, thereby reducing the burden of non-communicable diseases at the population level. Variability in the individual response to dietary interventions has been reported. Here a Dietary Metabotype Score is developed to embody those interindividual responses by coupling data from highly controlled dietary studies with urinary metabolic phenotypes. This score may offer a method to target and to enhance dietary response at the individual level, thereby reducing the burden of diet-related disease at the population level.

Demonization has been used as tool for the maintenance of ruling regimes throughout history. Institutionalized, it becomes regime policy, exemplified in the extreme by the German Nazi regime’s demo...

While conventional nutrition research has yielded biomarkers such as doubly labeled water for energy metabolism and 24-h urinary nitrogen for protein intake, a critical need exists for additional, equally robust biomarkers that allow for objective assessment of specific food intake and dietary exposure. Recent advances in high-throughput MS combined with improved metabolomics techniques and bioinformatic tools provide new opportunities for dietary biomarker development. In September 2018, the NIH organized a 2-d workshop to engage nutrition and omics researchers and explore the potential of multiomics approaches in nutritional biomarker research. The current Perspective summarizes key gaps and challenges identified, as well as the recommendations from the workshop that could serve as a guide for scientists interested in dietary biomarkers research. Topics addressed included study designs for biomarker development, analytical and bioinformatic considerations, and integration of dietary biomarkers with other omics techniques. Several clear needs were identified, including larger controlled feeding studies, testing a variety of foods and dietary patterns across diverse populations, improved reporting standards to support study replication, more chemical standards covering a broader range of food constituents and human metabolites, standardized approaches for biomarker validation, comprehensive and accessible food composition databases, a common ontology for dietary biomarker literature, and methodologic work on statistical procedures for intake biomarker discovery. Multidisciplinary research teams with appropriate expertise are critical to moving forward the field of dietary biomarkers and producing robust, reproducible biomarkers that can be used in public health and clinical research.

ObjectiveTo assess changes in daily call volumes to the US National Suicide Prevention Lifeline and in suicides during periods of wide scale public attention to the song “1-800-273-8255” by American hip hop artist Logic.DesignTime series analysis.SettingUnited States, 1 January 2010 to 31 December 2018.ParticipantsTotal US population. Lifeline calls and suicide data were obtained from Lifeline and the Centers for Disease Control and Prevention.Main outcome measuresDaily Lifeline calls and suicide data before and after the release of the song. Twitter posts were used to estimate the amount and duration of attention the song received. Seasonal autoregressive integrated moving average time series models were fitted to the pre-release period to estimate Lifeline calls and suicides. Models were fitted to the full time series with dummy variables for periods of strong attention to the song.ResultsIn the 34 day period after the three events with the strongest public attention (the song’s release, the MTV Video Music Awards 2017, and Grammy Awards 2018), Lifeline received an excess of 9915 calls (95% confidence interval 6594 to 13 236), an increase of 6.9% (95% confidence interval 4.6% to 9.2%, PConclusionsLogic’s song “1-800-273-8255” was associated with a large increase in calls to Lifeline. A reduction in suicides was observed in the periods with the most social media discourse about the song.

Frailty is a syndrome of growing importance given the global ageing population. While frailty is a multifactorial process, poor nutritional status is considered a key contributor to its pathophysiology. As nutrition is a modifiable risk factor for frailty, strategies to prevent and treat frailty should consider dietary change. Observational evidence linking nutrition with frailty appears most robust for dietary quality: for example, dietary patterns such as the Mediterranean diet appear to be protective. In addition, research on specific foods, such as a higher consumption of fruit and vegetables and lower consumption of ultra-processed foods are consistent, with healthier profiles linked to lower frailty risk. Few dietary intervention studies have been conducted to date, although a growing number of trials that combine supplementation with exercise training suggest a multi-domain approach may be more effective. This review is based on an interdisciplinary workshop, held in November 2020, and synthesises current understanding of dietary influences on frailty, focusing on opportunities for prevention and treatment. Longer term prospective studies and well-designed trials are needed to determine the causal effects of nutrition on frailty risk and progression and how dietary change can be used to prevent and/or treat frailty in the future.

This study examined data on acute (i.e., within 30 days) increases in suicides, help and information seeking, and service capacity after a celebrity suicide.Daily suicide data, call volume to the National Suicide Prevention Lifeline (NSPL), and visits to two suicide prevention Web sites before and after entertainer Robin Williams' death on August 11, 2014, were examined.Before August 11 in 2012, 2013, and 2014, daily suicide deaths averaged between 113 and 117; in 2014, the count increased to 142, an increase not observed in 2012 and 2013. The number of calls to the NSPL rose by up to 300%, but answered calls decreased from an average of 71% to 57%. Visits to both Web sites also increased dramatically.Dramatic increases in all three measured outcomes in the days after a celebrity suicide were noted, suggesting the need for contingency plans to meet immediate increased demand.

This article quantitatively investigates racial “othering” in Thailand by using available World Values Survey proxies. We review racial “othering” in Thailand through inter-group threat theory. We ...

Thailand is the world’s fourth most unequal country by wealth, but past research on this phenomenon has mainly been along individual or geographic lines as the census is insufficiently detailed to provide ethnic-based measures. This article introduces an innovative methodological solution to measure horizontal inequality in countries where the census excludes ethnicity. We investigate the roots of a structural ‘ethnic penalty’ by contextualising in some detail an ethnic gap in Thai public policies concerning poverty and inequality. Then, using data from the United Nations Development Programme’s ‘Human Achievement Index’ for Thailand, the Thai Office of the National Culture Commission’s Ethnolinguistic Maps of Thailand report, and Thai National Statistical Office population and poverty data, we compile the country’s first dataset on horizontal (between-group) inequality by ethnicity. Employing this novel approach, we then examine the eight sectors in the Human Achievement Index: health, education, employment, income, housing and living environment, transport and communication, family and community life, and participation. Describing how Thailand’s major ethnic groups fare in each sector and comparing inequality amongst sectors, this ethnolinguistics-based approach provides evidence of a significant ‘ethnic penalty’ in Thailand and makes initial recommendations for addressing the issue.