Introduction: Power to the image! Science, technology and visual diplomacy.

This special issue explores the power that images with a techno-scientific content can have in international relations. As we introduce the articles in the collection, we highlight how the study of this influence extends current research in the separate (but increasingly interacting) domains of history of science and technology, and political science. We then show how images of different types (photographs, cartoons and plots) can inform inter-state transactions through their public appeal alongside the better-studied dialogic practices of the diplomatic arena. Finally, we offer an analysis of the interlacing of different diplomatic tracks based on words and images and conclude that, in contrast with words, images conflate agency and argument, therefore creating opportunities to inform transactions and negotiations which their designers may not have even intended.

Showcasing the international atom: the IAEA Bulletin as a visual science diplomacy instrument, 1958-1962.

When the International Atomic Energy Agency (IAEA) began operations in 1958, one of its first routine tasks was to create and circulate a brief non-technical periodical. This article analyses the creation of the IAEA Bulletin and its circulation during its first years. It finds that diplomatic imperatives both in IAEA leadership circles and in the networks outside them shaped the form and appearance of the bulletin. In the hands of the IAEA's Division of Public Information, the bulletin became an instrument of science diplomacy, its imagery conveying the motivations for member states to strengthen ties with the IAEA, while simultaneously persuading them to accept the hierarchies and geopolitical logics implicit in those relations, as well as to endorse the central position of the IAEA as a clearing house and authority of globally circulating nuclear objects and information.

Medicalization of Exercise Through Vigilance, Productivity, and Self-Care: A Secondary Data Analysis of Qualitative Interviews Among Those With Multiple Sclerosis.

Exercise is becoming more integrated into the management of multiple sclerosis (MS) and is promoted to manage impairments and symptoms. Whereas extensive research outlines factors impacting participation, less is known regarding how medicalized exercise promotion might impact views of exercise and self. We conducted a secondary data analysis to understand how medicalized exercise-promotion paradigms impact the meaning and roles of exercise among those with MS. Twenty-two interviews were selected for reanalysis with an interpretative phenomenological analysis methodology and a critical disability studies lens. Three themes were identified: Constant Vigilance (worry about exercise), Productivity and Social Engagement (exercise to feel productive, engage socially, and enhance self-worth), and Exercise as Medicine/Self-Care (exercise to manage MS, relax, improve mental well-being, prevent/reverse disability, and stay healthy). This research underscores that exercise occupies many contradictory roles reflecting a medicalized exercise-promotion paradigm for those with MS, and this should inform exercise promotion practices.

Identifying the sources of structural sensitivity in partially specified biological models.

Biological systems are characterised by a high degree of uncertainty and complexity, which implies that exact mathematical equations to describe biological processes cannot generally be justified. Moreover, models can exhibit sensitivity to the precise formulations of their component functions-a property known as structural sensitivity. Structural sensitivity can be revealed and quantified by considering partially specified models with uncertain functions, but this goes beyond well-established, parameter-based sensitivity analysis, and currently presents a mathematical challenge. Here we build upon previous work in this direction by addressing the crucial question of identifying the processes which act as the major sources of model uncertainty and those which are less influential. To achieve this goal, we introduce two related concepts: (1) the gradient of structural sensitivity, accounting for errors made in specifying unknown functions, and (2) the partial degree of sensitivity with respect to each function, a global measure of the uncertainty due to possible variation of the given function while the others are kept fixed. We propose an iterative framework of experiments and analysis to inform a heuristic reduction of structural sensitivity in a model. To demonstrate the framework introduced, we investigate the sources of structural sensitivity in a tritrophic food chain model.

Forecasting resilience profiles of the run-up to regime shifts in nearly-one-dimensional systems.

The forecasting of sudden, irreversible shifts in natural systems is a challenge of great importance, whose realization could allow pre-emptive action to be taken to avoid or mitigate catastrophic transitions, or to help systems adapt to them. In recent years, there have been many advances in the development of such early warning signals. However, much of the current toolbox is based around the tracking of statistical trends and therefore does not aim to estimate the future time scale of transitions or resilience loss. Metric-based indicators are also difficult to implement when systems have inherent oscillations which can dominate the indicator statistics. To resolve these gaps in the toolbox, we use additional system properties to fit parsimonious models to dynamics in order to predict transitions. Here, we consider nearly-one-dimensional systems-higher dimensional systems whose dynamics can be accurately captured by one-dimensional discrete time maps. We show how the nearly one-dimensional dynamics can be used to produce model-based indicators for critical transitions which produce forecasts of the resilience and the time of transitions in the system. A particularly promising feature of this approach is that it allows us to construct early warning signals even for critical transitions of chaotic systems. We demonstrate this approach on two model systems: of phosphorous recycling in a shallow lake, and of an overcompensatory fish population.

Cancer Communication Outside of the Physician-Patient Relationship: The Experience of Communicating and Understanding the Meaning of Prognosis.

RESEARCH QUESTION: How does the process of engagement and integration of sources of information outside patient-physician interaction affect how individuals with cancer interpret their treatment experience and prognosis? BACKGROUND: Studies of patient-physician communication of prognosis in oncology highlight areas where misunderstanding occurs: understanding consequences of treatment, likelihood of treatment success, probability of cure, status/progression of illness, and prognosis. Theories proposing mechanisms that underlie this discrepancy cannot account for all instances of misunderstanding, including when complete and direct physician disclosure occurs. Prior research focused on patient-physician communication event(s) and immediate antecedents and consequences. However, less is known about what happens to information once it has been communicated and how a patient's process to interpret the meaning of their experience affects their understanding of it. Our study explores this question by examining patient communication with sources of information other than treating physicians. METHODOLOGY: We conducted 10 semi-structured qualitative interviews with individuals diagnosed with 4 types of cancer at different stages. The interviews were analyzed using inductive qualitative analysis. RESULTS: Participants in our sample consulted a variety of additional sources to give context and understanding to their communicated prognosis. These were important contributors to how they understood their prognosis and incorporated that understanding. They included family, friends/acquaintances, cancer survivors, support/survivor groups, secondary health-care staff, and relevant informational materials. Different motivations for seeking out these sources were also expressed. Participants expressed a link between their understanding of their prognosis and the variety of outside sources they enlisted for input and support.

The Doctor-Patient Relationship and Information-Seeking Behavior: Four Orientations to Cancer Communication.

BACKGROUND: In cancer communication, patients and physicians often understand a patient's experience and situation differently. This can negatively impact health outcomes and the physician-patient relationship. AIM: To explore how cancer patients' interpretations of the physician's role as information giver affect the communication relationship with the physician and their information-seeking behavior regarding different aspects of their cancer care. DESIGN: Participants completed a semistructured qualitative interview addressing their treatment experience and communication with their physician. Interviews were coded and analyzed using inductive thematic analysis. SETTING/PARTICIPANTS: Ten patients with cancer treated at a regional cancer center in central Illinois participated in the study. Cancer stages I to IV and 4 cancer types were represented. RESULTS: Participants' orientations to the relationship with their physician (and their information-seeking behavior) were classified into 4 general categories: (1) "questioners" have a general mistrust toward their physicians and the information doctors are giving; (2) "the undecided" focuses on physician "fit," often requiring time to step away in order to make decisions and process information; (3) "cross-checkers" are concerned with content of their treatment protocol, often double-checking the treatment plan; and (4) "the experience-oriented" feel a gap between their experience and their physician's experience (and perspective), often seeking information from other survivors. All categories described a perceived lack of adequate exchange of information and the need to seek information outside of the physician-patient relationship to compensate. CONCLUSION: Participants exhibited different information-seeking behaviors based on how they interpreted the role of their physician as information giver. This affected what kind of information they sought and how they understood the information received, which in turn affected understanding of their broader experience and care.

The Added Value of Exercise Variables in Heart Failure Prognosis.

INTRODUCTION: Diminished exercise capacity is a key symptom in heart failure (HF). Exercise predictors (peak VO2, VE/VCO2 slope, and oxygen uptake efficiency slope [OUES]) are prognostic markers but studied in isolation. We evaluated if these exercise variables offer additional prognostic value to clinical predictors in HF. METHODS AND RESULTS: This was a single-institution retrospective cohort study of 517 consecutive HF patients. We used Cox proportional hazards modeling to determine the additional prognostic value of exercise variables on mortality, HF hospital admissions, and a composite outcome of ventricular assistance device (VAD) implantation, heart transplantation (HT), and death. During a mean follow-up of 2.7 years, 52 deaths, 47 HTs, and 19 VAD implantations occurred. After adjusting for age, New York Heart Association functional class, ejection fraction, body mass index, creatinine, and B-type natriuretic peptide, peak VO2 (hazard ratio [HR] 0.91, 95% confidence interval [CI] 0.85-0.96), OUES (HR 0.92, 95% CI 0.87-0.97), and VE/VCO2 (HR 1.03, 95% CI 1.01-1.05) were independent predictors of the composite outcome. Similar discriminatory capacity existed between the exercise variables (c-statistics 0.77, 0.78, and 0.78, respectively). Only VE/VCO2 was an independent predictor of admissions (HR 1.04, 95% CI 1.01-1.07), and only peak VO2 was an independent predictor of mortality (HR 0.90, 95% CI 0.84-0.98). CONCLUSIONS: Peak VO2, OUES, and VE/VCO2 are independent predictors of HF prognosis over recognized clinical variables. However, no single exercise variable was superior.

Les liaisons dangereuses: resource surveillance, uranium diplomacy and secret French-American collaboration in 1950s Morocco.

This study explores the origins and consequences of a unique, secret, French-American collaboration to prospect for uranium in 1950s Morocco. This collaboration permitted mediation between the United States and France. The appearance of France in an American-supported project for raw nuclear materials signalled American willingness to accept a new nuclear global order in which the French assumed a new, higher position as regional nuclear ally as opposed to suspicious rival. This collaboration also permitted France and the United States to agree tacitly to the same geopolitical status for the French Moroccan Protectorate, a status under dispute both in Morocco and outside it. The secret scientific effort reassured the French that, whatever the Americans might say publicly, they stood behind the maintenance of French hegemony in the centuries-old kingdom. But Moroccan independence proved impossible to deny. With its foreseeable arrival, the collaboration went from seductive to dangerous, and the priority of American and French geologists shifted from finding a major uranium lode to making sure that nothing was readily available to whatever post-independence interests might prove most powerful. Ultimately, the Kingdom of Morocco took a page out of the French book, using uranium exploration to assert sovereignty over a different disputed territory, its de facto colony of the Western Sahara.

Helmet-Wearing Practices and Barriers in Toronto Bike-Share Users: a Case-Control Study.

BACKGROUND: Helmet use among bike-share users is low. We sought to characterize helmet-use patterns, barriers to helmet use, and cycling safety practices among bike-share users in Toronto. METHODS: A standardized survey of public bike-share program (PBSP) users at semi-random distribution of PBSP stations was undertaken. By maintaining a ratio of one helmet-wearer (HW): two non-helmet-wearers (NHW) per survey period, we controlled for location, day, time, and weather. RESULTS: Surveys were completed on 545 (180 HW, 365 NHW) unique users at 48/80 PBSP locations, from November 2012 to August 2013. More females wore helmets (F: 41.1%, M: 30.9%, p=0.0423). NHWs were slightly younger than HWs (NHW mean age 34.4 years vs HW 37.3, p=0.0018). The groups did not differ by employment status, education, or income. Helmet ownership was lower among NHWs (NHW: 62.4% vs HW: 99.4%, p<0.0001), as was personal bike ownership (NHW: 65.8%, vs HW: 78.3%, p=0.0026). NHWs were less likely to always wear a helmet on personal bikes (NHW: 22.2% vs HW: 66.7%, p<0.0001), and less likely to wear a helmet always or most of the time on PBSP (NHW: 5.8% vs HW: 92.3%, p<0.0001). Both groups, but more HWs, had planned to use PBSP when leaving their houses (HW: 97.2% vs NHW: 85.2%, p<0.0001), primarily to get to work (HW: 88.3% vs NHW: 84.1%, p=0.19). NHWs were more likely to report that they would wear a helmet more (NHW: 61.4% vs HW: 13.9%, p<0.0001), and/or cycle less (NHW: 22.5% vs HW: 4.4%) if helmet use was mandatory. CONCLUSIONS: PBSP users surveyed appear to make deliberate decisions regarding helmet use. NHWs tended to be male, slightly younger, and less likely to use helmets on their personal bikes. As Toronto cyclists who do not wear helmets on PBSP generally do not wear helmets on their personal bikes, interventions to increase helmet use should target both personal and bike-share users. Legislating helmet use and provision of rental helmets could improve helmet use among bike-share users, but our results suggest some risk of reduced cycling with legislation.

The prevalence of hypoxaemia among ill children in developing countries: a systematic review.

Hypoxaemia is a common complication of childhood infections, particularly acute lower respiratory tract infections. In pneumonia-a disease that disproportionately impacts developing countries, and accounts for more than two million deaths of children worldwide-hypoxaemia is a recognised risk factor for death, and correlates with disease severity. Hypoxaemia also occurs in severe sepsis, meningitis, common neonatal problems, and other conditions that impair ventilation and gas exchange or increase oxygen demands. Despite this, hypoxaemia has been overlooked in worldwide strategies for pneumonia control and reducing child mortality. Hypoxaemia is also often overlooked in developing countries, mainly due to the low accuracy of clinical predictors and the limited availability of pulse oximetry for more accurate detection and oxygen for treatment. In this Review of published and unpublished studies of acute lower respiratory tract infection, the median prevalence of hypoxaemia in WHO-defined pneumonia requiring hospitalisation (severe and very severe classifications) was 13%, but prevalence varied widely. This corresponds to at least 1.5 to 2.7 million annual cases of hypoxaemic pneumonia presenting to health-care facilities. Many more people do not access health care. With mounting evidence of the impact that improved oxygen systems have on mortality due to acute respiratory infection in limited-resource health-care facilities, there is a need for increased awareness of the burden of hypoxaemia in childhood illness.