Hand hygiene is a simple, low-cost intervention that may lead to substantial population-level effects in suppressing acute respiratory infection epidemics. However, quantification of the efficacy of hand hygiene on respiratory infection in the community is lacking. We searched PubMed for randomised controlled trials on the effect of hand hygiene for reducing acute respiratory infections in the community published before 11 March 2021. We performed a meta-regression analysis using a Bayesian mixed-effects model. A total of 105 publications were identified, out of which six studies reported hand hygiene frequencies. Four studies were performed in household settings and two were in schools. The average number of handwashing events per day ranged from one to eight in the control arms, and four to 17 in the intervention arms. We estimated that a single hand hygiene event is associated with a 3% (80% credible interval (−1% to 7%)) decrease in the daily probability of an acute respiratory infection. Three of these six studies were potentially at high risk of bias because the primary outcome depended on self-reporting of upper respiratory tract symptoms. Well-designed trials with an emphasis on monitoring hand hygiene adherence are needed to confirm these findings.

In this paper I return to Hegel's dispute with Kant over the conceptual ordering of external and internal purposiveness to distinguish between two conceptions of teleology at play in the contemporary function debate. I begin by outlining the three main views in the debate (the etiological, causal role and organizational views). I argue that only the organizational view can maintain the capacity of function ascriptions both to explain the presence of a trait and to identify its contribution to a current system, for it is the only view that considers teleology as a natural cause. To establish how teleology can be considered as a natural cause, advocates of the organizational view return to Kant's analysis of internal purposiveness. However, while Kant identifies the requirements that an object must meet to satisfy the demands of teleological judgment, I suggest that he denies that we can know whether they are truly met. I argue that Hegel's philosophy of nature is better equipped to determine how internal purposiveness can be considered as a natural cause, for it grounds organization in a form of purposiveness that is more fundamental than a designer's intention.

Beginning with loose aggregations of dust particles coated with heterogeneous ices under vacuum at Kuiper Belt temperatures, moving to Jupiter/Saturn distances and eventually to low-perihelion orbit, we consider the likely development of the gaseous phase within a cometary nucleus over the course of its lifetime. From the perspective of physical chemistry, we consider limits on the spatial and temporal distribution and composition of this gaseous phase. The implications of the gaseous phase for heat transfer and for the possible spatial and temporal development of liquid phases are calculated. We conclude that the likely temperatures, pressures, and compositions beneath the outer crust of typical cometary nuclei are such that fluidised phases can exist at significant depths and that these reservoirs give a coherent explanation for the high-intensity outbursts observed from cometary nuclei at large distances from perihelion.

Recent years have seen a surge in interest in mental healthcare and some reduction in stigma. Partly as a result of this, alongside a growing population and higher levels of societal distress, many more people are presenting with mental health needs, often in crisis. Systems that date back to the beginning of the National Health Service still form the basis for much care, and the current system is complex, hard to navigate and often fails people. Law enforcement services are increasingly being drawn into providing mental healthcare in the community, which most believe is inappropriate. We propose that it is now time for a fundamental root and branch review of mental health emergency care, taking into account the views of patients and the international evidence base, to ‘reset’ the balance and commission services that are humane and responsive – services that are fit for the 21st century.

We investigated the impact of discontinuation of contact precautions for methicillin-resistant Staphylococcus aureus and vancomycin-resistant Enterococcus infected or colonized patients on central-line associated bloodstream infection rates at an academic children’s hospital. Discontinuation of contact precautions with a bundled horizontal infection prevention platform resulted in no adverse impact on CLABSI rates.

This article develops the concept of ‘frontline diplomacy’ – what practitioners referring to work in embassies, consulates, and permanent representation as ‘the field’ –, defined here as all diplomats’ activities taking place away from headquarters. IR scholarship tends to focus on Ministries of Foreign Affairs located in capitals. On the contrary, building on the practice turn in IR, we first show that international politics emerge from frontline practices. Adding to criticism against the practice turn, we then explain that it has missed important transformations occurring in frontline diplomacy because it tends to privilege stability over change. We finally discuss two innovations in frontline practices: the action of Sherpas in G20 summits following the 2008 crisis and the use of Twitter by US Ambassador to Russia Michael McFaul (2012–14). For each we answer three questions: How do these activities transform traditional modes of operation? How are non-state actors involved in them? What do they tell about transformation of global politics? Because diplomatic practices at the frontlines epitomise international politics, these new directions for inquiry contribute substantively to IR scholarship. At the theoretical level, they enrich the continuing encounter between IR and diplomatic studies through practice theory and help to understand change in practice.

Prisoner's Dilemma (PD) games have become a well-established paradigm for studying the mechanisms by which cooperative behavior may evolve in societies consisting of selfish individuals. Recent research has focused on the effect of spatial and connectivity structure in promoting the emergence of cooperation in scenarios where individuals play games with their neighbors, using simple “memoryless” rules to decide their choice of strategy in repeated games. While heterogeneity and structural features such as clustering have been seen to lead to reasonable levels of cooperation in very restricted settings, no conditions on network structure have been established, which robustly ensure the emergence of cooperation in a manner that is not overly sensitive to parameters such as network size, average degree, or the initial proportion of cooperating individuals. Here, we consider a natural random network model, with parameters that allow us to vary the level of “community” structure in the network, as well as the number of high degree hub nodes. We investigate the effect of varying these structural features and show that, for appropriate choices of these parameters, cooperative behavior does now emerge in a truly robust fashion and to a previously unprecedented degree. The implication is that cooperation (as modelled here by PD games) can become the social norm in societal structures divided into smaller communities, and in which hub nodes provide the majority of inter-community connections.

Introduction: Telephone quitlines are an easily accessible and effective means for delivering cessation services including nicotine replacement therapy (NRT). Varenicline (VAR) may show superior quit rates to NRT, but has not been routinely evaluated in the context of quitlines.

Aims: To assess the feasibility of distributing VAR through a quitline, and preliminarily compare cessation rates between participants receiving VAR and NRT.

Methods: Participants were recruited through the New York State Smokers’ Quitline. Those randomised to VAR (n = 200) were instructed to obtain a prescription from their primary care physician (PCP) to be filled by mail through the research pharmacy. Those randomised to NRT (n = 100) were mailed NRT using an existing protocol. Outcome measures were number of submitted prescriptions and dispensed medication kits, and self-reported 7-day point prevalence abstinence at follow-up.

Results: The research pharmacy filled 100% of prescriptions through the quitline. However, only 27% of the VAR Arm submitted a prescription. An intent-to-treat analysis revealed that those receiving NRT were more likely to be abstinent at follow-up than the VAR Arm (OR, 2.42; 95% CI, 1.27–4.60; p < 0.01). The per-protocol analysis, which only included those in the VAR Arm who submitted a prescription, showed no difference in quit rates.

Conclusions: The present protocol resulted in successful delivery of VAR through the quitline, but a sizable proportion of the VAR Arm did not submit a prescription. Self-reported barriers included being unable to obtain a prescription from a PCP. Future studies should explore alternative methods for delivering VAR through quitlines.

Forest ecosystems in South Africa are at risk from a variety of anthropogenic threats impacting the faunal species dependent on them. These impacts often differ depending on species-specific characteristics. Range data on forest dependent bird species from the South African Bird Atlas Project (SABAP1 and SABAP2) were analysed to determine links between deforestation, species characteristics and range declines. Half of the species studied were found to have declining ranges. Range change data for these species were correlated with data on changes in land cover from 1990 to 2014. To determine which land cover changes affect extinction, occupancy was modelled for 30 sites across South Africa which experienced a loss of more than 10 species. Most species lost were birds of prey or insectivores. Indigenous forest decreased in 17% (n = 5) sites, while plantations/woodlots decreased in 60% (n = 18) sites. Occupancy modelling showed extinction to be mitigated by plantations in 6/28 species, and forest expansion mitigated extinction in 7/28 species. Responses to deforestation did not appear to be related to particular species characteristics. Half of South Africa’s forest-dependent bird species have declining ranges, with the loss of these species most prominent in the Eastern Cape province. Four responses to changes in forest and plantation cover are discussed: direct effects, with forest loss causing species loss; matrix effects, where plantation loss resulted in species loss; degradation of indigenous forest; and the advent of new forest arising from woody thickening caused by carbon fertilisation, which may not result in optimal habitat for forest-dependent birds.

We investigate symbolic and regular powers of monomial ideals. For a square-free monomial ideal I ⊆ 𝕜[x0, … , xn] we show that for all positive integers m, t and r, where e is the big-height of I and . This captures two conjectures (r = 1 and r = e): one of Harbourne and Huneke, and one of Bocci et al. We also introduce the symbolic polyhedron of a monomial ideal and use this to explore symbolic powers of non-square-free monomial ideals.