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26 pages, 2465 KB  
Article
Referent Reintroduction in the Japanese Narratives of Bilingual Children: The Relationship Between Referent Accessibility and Explicitness
by Satomi Mishina-Mori, Yuri Jody Yujobo and Yuki Nakano
Languages 2025, 10(12), 294; https://doi.org/10.3390/languages10120294 - 29 Nov 2025
Viewed by 334
Abstract
Studies of children’s narratives have shown that selecting appropriate forms to reintroduce a referent compared to retaining a referent is challenging because it requires the integration of different accessibility features. Bilingual children are more explicit than their monolingual peers when it comes to [...] Read more.
Studies of children’s narratives have shown that selecting appropriate forms to reintroduce a referent compared to retaining a referent is challenging because it requires the integration of different accessibility features. Bilingual children are more explicit than their monolingual peers when it comes to referent selection, especially in the context of reintroduction in null-argument languages. Whether different accessibility features influence referent choice in the context of reintroduction in bilingual and monolingual children remains to be investigated. Japanese narratives were elicited from Japanese–English school-age early bilinguals (n = 13) and their monolingual peers (n = 8) using a wordless picture book and video clip, and the linguistic means of referent reintroduction were analyzed in terms of recency, ambiguity, and pragmatic predictability. The analysis revealed that in terms of recency, bilinguals used more noun phrases (NPs) than null forms when the referent was highly accessible, thus exhibiting overexplicitness, whereas in terms of ambiguity, bilinguals used more NPs for less accessible referents, while monolinguals were not as explicit. Both groups were sensitive to accessibility. We argue that bilinguals are selectively redundant, suggesting that the overproduction is not due to the load of processing two languages but is a manifestation of cross-linguistic influence modulated by accessibility features. The results emphasize the importance of considering discourse features in identifying overexplicitness. Full article
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25 pages, 3707 KB  
Article
Scope Without Scope Economy in Null Argument Constructions
by Bum-Sik Park and Sei-Rang Oh
Languages 2025, 10(11), 278; https://doi.org/10.3390/languages10110278 - 31 Oct 2025
Viewed by 548
Abstract
Building on Fox’s Scope Economy, Takahashi proposes an analysis of scope interactions in Japanese null argument constructions. Scope Economy prevents covert scope-shifting operations such as Quantifier Raising (QR) from being semantically vacuous. Equating scrambling of Japanese null arguments with QR, Takahashi argues that [...] Read more.
Building on Fox’s Scope Economy, Takahashi proposes an analysis of scope interactions in Japanese null argument constructions. Scope Economy prevents covert scope-shifting operations such as Quantifier Raising (QR) from being semantically vacuous. Equating scrambling of Japanese null arguments with QR, Takahashi argues that null arguments are also subject to Scope Economy and thus exhibit the same scope asymmetries observed in English VP-ellipsis. In this paper, we examine Korean null argument constructions, which exhibit the same patterns as their Japanese counterparts, and argue that Takahashi’s Scope Economy-based account falls short of capturing the full range of scope facts. Specifically, we show that scope asymmetries persist even when Scope Economy-violating scrambling takes place. This problem is not confined to null argument constructions but also arises in fragments. We argue that Schwarzschild’s GIVENness constraint, in conjunction with Parallelism, accounts for scope patterns in Korean null argument constructions, without recourse to Scope Economy. We further suggest that the proposed analysis can extend to English, thereby undermining the necessity of Scope Economy in both languages. Full article
11 pages, 1850 KB  
Article
Too Much Terror: A Gigantic Terror Bird (Cariamiformes: Phorusrhacidae) from the Middle Miocene of La Venta, Colombia
by Federico J. Degrange, Siobhán B. Cooke, Luis G. Ortiz-Pabón, Jonathan S. Pelegrin, César A. Perdomo, Rodolfo Salas-Gismondi and Andrés Link
Diversity 2025, 17(10), 681; https://doi.org/10.3390/d17100681 - 29 Sep 2025
Viewed by 3106
Abstract
Phorusrhacids correspond to a group of birds considered to be apex predators, which are a common element of the American fossil Cenozoic avifauna, especially in Argentina, where it is not unusual to find at least two species of terror birds. Nevertheless, the presence [...] Read more.
Phorusrhacids correspond to a group of birds considered to be apex predators, which are a common element of the American fossil Cenozoic avifauna, especially in Argentina, where it is not unusual to find at least two species of terror birds. Nevertheless, the presence of more than one species of terror bird outside Argentina is null. Here we report a second terror bird from the middle Miocene of La Venta locality. The new specimen could reach approximately 180 kg, being about 15% larger than the previous report of a terror bird for the locality. Although it is not possible to completely discard the possibility of these two specimens belonging to a dimorphic species, morphological differences may indicate so. Certainly, the presence of two gigantic terror birds coexisting in the La Venta locality represents an interesting scenario for further studies on their ecology and niche partitioning; this could be an argument for the presence of large open areas within the forests and wetlands of La Venta, further supporting the complex and diverse ecosystems in this region during the Middle Miocene period. Full article
(This article belongs to the Collection Feature Papers in Phylogeny and Evolution)
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23 pages, 385 KB  
Article
The Syntax of Null Possessors with Kinship Terms and Body Part Nouns in Vietnamese
by Andrew Simpson and Linh Pham
Languages 2025, 10(7), 158; https://doi.org/10.3390/languages10070158 - 27 Jun 2025
Viewed by 699
Abstract
Bare nouns representing kinship terms (KNs) and body parts (BPNs) can be assumed to project a null possessor argument, which allows for the interpretation of such nouns relative to other linguistically present NPs. In Vietnamese, the distribution of KNs and BPNs is subject [...] Read more.
Bare nouns representing kinship terms (KNs) and body parts (BPNs) can be assumed to project a null possessor argument, which allows for the interpretation of such nouns relative to other linguistically present NPs. In Vietnamese, the distribution of KNs and BPNs is subject to different locality conditions and leads to the analysis of null possessors with KNs as covert anaphors, while null possessors with BPNs are null pronominals (pro). This contrasts with Mandarin Chinese, where it has been suggested that null possessors of KNs and BPNs are two different types of null anaphors. The observed distributional differences and analyses of bare KNs and BPNs in Vietnamese vs. Chinese raise questions of parametric variation with regard to null elements with parallel interpretive properties and also whether linking mechanisms may occur with other bare nouns without the projection of null possessors that are subject to binding theoretic locality restrictions. Full article
(This article belongs to the Special Issue Current Issues in Vietnamese Linguistics)
23 pages, 317 KB  
Article
On the Symbols of Strictly m-Null Elementary Operators
by Isabel Marrero
Mathematics 2025, 13(12), 2026; https://doi.org/10.3390/math13122026 - 19 Jun 2025
Cited by 1 | Viewed by 863
Abstract
This paper extends the previous work by the author on m-null pairs of operators in Hilbert space. If an elementary operator L has elementary symbols A and B that are p-null and q-null, respectively, then L is  [...] Read more.
This paper extends the previous work by the author on m-null pairs of operators in Hilbert space. If an elementary operator L has elementary symbols A and B that are p-null and q-null, respectively, then L is (p+q1)-null. Here, we prove the converse under strictness conditions, modulo some nonzero multiplicative constant—if L is strictly (p+q1)-null, then a scalar λ0 exists such that λA is strictly p-null and λ1B is strictly q-null. Our constructive argument relies essentially on algebraic and combinatorial methods. Thus, the result obtained by Gu on m-isometries is recovered without resorting to spectral analysis. For several operator classes that generalize m-isometries and are subsumed by m-null operators, the result is new. Full article
(This article belongs to the Section C: Mathematical Analysis)
34 pages, 397 KB  
Article
Hilbert Bundles and Holographic Space–Time Models
by Tom Banks
Astronomy 2025, 4(2), 7; https://doi.org/10.3390/astronomy4020007 - 22 Apr 2025
Viewed by 1693
Abstract
We reformulate holographic space–time models in terms of Hilbert bundles over the space of the time-like geodesics in a Lorentzian manifold. This reformulation resolves the issue of the action of non-compact isometry groups on finite-dimensional Hilbert spaces. Following Jacobson, I view the background [...] Read more.
We reformulate holographic space–time models in terms of Hilbert bundles over the space of the time-like geodesics in a Lorentzian manifold. This reformulation resolves the issue of the action of non-compact isometry groups on finite-dimensional Hilbert spaces. Following Jacobson, I view the background geometry as a hydrodynamic flow, whose connection to an underlying quantum system follows from the Bekenstein–Hawking relation between area and entropy, generalized to arbitrary causal diamonds. The time-like geodesics are equivalent to the nested sequences of causal diamonds, and the area of the holoscreen (The holoscreen is the maximal d2 volume (“area”) leaf of a null foliation of the diamond boundary. I use the term area to refer to its volume.) encodes the entropy of a certain density matrix on a finite-dimensional Hilbert space. I review arguments that the modular Hamiltonian of a diamond is a cutoff version of the Virasoro generator L0 of a 1+1-dimensional CFT of a large central charge, living on an interval in the longitudinal coordinate on the diamond boundary. The cutoff is chosen so that the von Neumann entropy is lnD, up to subleading corrections, in the limit of a large-dimension diamond Hilbert space. I also connect those arguments to the derivation of the ’t Hooft commutation relations for horizon fluctuations. I present a tentative connection between the ’t Hooft relations and U(1) currents in the CFTs on the past and future diamond boundaries. The ’t Hooft relations are related to the Schwinger term in the commutator of the vector and axial currents. The paper in can be read as evidence that the near-horizon dynamics for causal diamonds much larger than the Planck scale is equivalent to a topological field theory of the ’t Hooft CR plus small fluctuations in the transverse geometry. Connes’ demonstration that the Riemannian geometry is encoded in the Dirac operator leads one to a completely finite theory of transverse geometry fluctuations, in which the variables are fermionic generators of a superalgebra, which are the expansion coefficients of the sections of the spinor bundle in Dirac eigenfunctions. A finite cutoff on the Dirac spectrum gives rise to the area law for entropy and makes the geometry both “fuzzy” and quantum. Following the analysis of Carlip and Solodukhin, I model the expansion coefficients as two-dimensional fermionic fields. I argue that the local excitations in the interior of a diamond are constrained states where the spinor variables vanish in the regions of small area on the holoscreen. This leads to an argument that the quantum gravity in asymptotically flat space must be exactly supersymmetric. Full article
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67 pages, 689 KB  
Article
New Applications of Elliptic Functions and Integrals in GPS Inter-Satellite Communications with Account of General Relativity Theory
by Bogdan Dimitrov
Mathematics 2025, 13(8), 1286; https://doi.org/10.3390/math13081286 - 14 Apr 2025
Cited by 2 | Viewed by 1213
Abstract
During the last 15–20 years, the experimental methods for autonomous navigation and inter-satellite links have been developing rapidly in order to ensure navigation control and data processing without commands from Earth stations. Inter-satellite links are related to relative ranging between the satellites from [...] Read more.
During the last 15–20 years, the experimental methods for autonomous navigation and inter-satellite links have been developing rapidly in order to ensure navigation control and data processing without commands from Earth stations. Inter-satellite links are related to relative ranging between the satellites from one constellation or different constellations and measuring the distances between them with the precision of at least 1 μm micrometer (=106 m), which should account for the bending of the light (radio or laser) signals due to the action of the Earth’s gravitational field. Thus, the theoretical calculation of the propagation time of a signal should be described in the framework of general relativity theory and the s.c. null cone equation. This review paper summarizes the latest achievements in calculating the propagation time of a signal, emitted by a GPS satellite, moving along a plane elliptical orbit or a space-oriented orbit, described by the full set of six Kepler parameters. It has been proved that for the case of plane elliptical orbit, the propagation time is expressed by a sum of elliptic integrals of the first, the second and the third kind, while for the second case (assuming that only the true anomaly angle is the dynamical parameter), the propagation time is expressed by a sum of elliptic integrals of the second and of the fourth order. For both cases, it has been proved that the propagation time represents a real-valued expression and not an imaginary one, as it should be. For the typical parameters of a GPS orbit, numerical calculations for the first case give acceptable values of the propagation time and, especially, the Shapiro delay term of the order of nanoseconds, thus confirming that this is a propagation time for the signal and not for the time of motion of the satellite. Theoretical arguments, related to general relativity and differential geometry have also been presented in favor of this conclusion. A new analytical method has been developed for transforming an elliptic integral in the Legendre form into an integral in the Weierstrass form. Two different representations have been found, one of them based on the method of four-dimensional uniformization, exposed in the monograph of Whittaker and Watson. The result of this approach is a new formulae for the Weierstrass invariants, depending in a complicated manner on the modulus parameter q of the elliptic integral in the Legendre form. Full article
(This article belongs to the Special Issue Advances in Elliptic Equations and Their Applications)
23 pages, 3080 KB  
Article
Null Subjects in Non-Pro-Drop Languages: The Lens on French
by Mara Frascarelli and Giorgio Carella
Languages 2024, 9(12), 363; https://doi.org/10.3390/languages9120363 - 27 Nov 2024
Cited by 1 | Viewed by 3272
Abstract
The contrast between languages such as Italian that allow subjects of tensed sentences to be null (i.e., pro-drop languages) and those like French that do not (i.e., non-pro-drop languages) is a classic issue for comparative syntactic research. Nevertheless, while several studies have been [...] Read more.
The contrast between languages such as Italian that allow subjects of tensed sentences to be null (i.e., pro-drop languages) and those like French that do not (i.e., non-pro-drop languages) is a classic issue for comparative syntactic research. Nevertheless, while several studies have been dedicated to pro-drop languages, distinguishing across different types, subject omission in non-pro-drop languages is generally misjudged as a marginal or substandard phenomenon. However, a more careful examination reveals that the occurrence of Null Subjects (NSs) in non-pro-drop languages is associated with distinct semantic and discourse imports. Based on a systematic corpus analysis, this work will confirm that NSs do occur in Colloquial French, especially in the case of expletive subjects. Furthermore, evidence will be provided for a crucial connection between subject omission, expletive types, and the morpho-syntactic categories of person/number for argument pronouns. This pilot work can thus open new perspectives for future research. Full article
(This article belongs to the Special Issue Syntax and Discourse at the Crossroads)
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25 pages, 698 KB  
Review
Alternate Stable States Theory: Critical Evaluation and Relevance to Marine Conservation
by Jean-Marc Guarini and Jennifer Coston-Guarini
J. Mar. Sci. Eng. 2024, 12(2), 261; https://doi.org/10.3390/jmse12020261 - 31 Jan 2024
Cited by 4 | Viewed by 3643
Abstract
In their 2023 book, “The Blue Compendium: From Knowledge to Action for a Sustainable Ocean Economy”, Lubchenko and Haugan invoked alternate stable (AS) states marginally as an undesired consequence of sources of disturbance on populations, communities and ecosystems. They did not provide detailed [...] Read more.
In their 2023 book, “The Blue Compendium: From Knowledge to Action for a Sustainable Ocean Economy”, Lubchenko and Haugan invoked alternate stable (AS) states marginally as an undesired consequence of sources of disturbance on populations, communities and ecosystems. They did not provide detailed arguments, but considered the existence of AS states as a given. Conversely, May, in his 1977 Nature article, pointed out that, when applied to systems that are complex, “the [AS states] theory remains largely metaphorical”. This is the starting point of this critical review, which aims to re-examine the general theory behind AS states in ecological systems and its applications to marine ecology and conservation. The focus is first on theory, taking as examples communities that sustain competition and studying the relative importance of the fluxes of individuals between simple low-dimension, interconnected systems. We find that a minimal formulation of fluxes is sufficient to obtain a set of non-null multiple stable (MS) states and to trigger shifts between AS states when fluxes become large enough. This provides new insights into the theory of rescue and mass effects by distinguishing them through a threshold at which the system dynamics shift from one stable equilibrium to another. Then, we consider how the theoretical framework of AS states has been applied in marine environments. It appears that many applications have confounded shifts between AS states and changes in the structure of systems, particularly when the complexity of the systems increases. The main difficulty for any application remains that the concepts of MS and AS states can only be established and validated for low-dimension systems and simplified experiments. This is because the mathematical properties of models that describe large-dimension, complex systems deviate from the observed characteristics of their real-world counterparts. There are many intriguing scientific challenges around the plausible shifts between AS states, but a deeper understanding and characterization of their occurrence in nature would require a significant investment in modeling to formulate predictive ecosystem models. Full article
(This article belongs to the Topic Marine Ecology, Environmental Stress and Management)
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18 pages, 348 KB  
Article
Grammatical Object Passives in Yucatec Spanish
by Grant Armstrong
Languages 2024, 9(1), 24; https://doi.org/10.3390/languages9010024 - 10 Jan 2024
Viewed by 2159
Abstract
Yucatec Spanish displays a type of sentence that appears to mix elements of an active impersonal and a passive. For example, “te castigaron por mi tío” may be interpreted as “you were punished by my uncle”, where a by-phrase headed by the preposition [...] Read more.
Yucatec Spanish displays a type of sentence that appears to mix elements of an active impersonal and a passive. For example, “te castigaron por mi tío” may be interpreted as “you were punished by my uncle”, where a by-phrase headed by the preposition por introduces an agent rather than a cause or reason. The verb has active morphology—it is always third-person plural, and accusative clitics (e.g., te) and DOM-marked objects are possible. This type of sentence, which I descriptively label an active–passive (A-P) hybrid, has been mentioned in previous literature on contact varieties in Mayan-speaking regions of Mexico and Guatemala, but it has not been precisely described or analyzed formally. I argue that A-P hybrid constructions are instances of grammatical object passives. Grammatical object passives have certain active properties—accusative case is assigned to a theme argument and the morphology of the verb is active, but like passives, they require that the expression of the agent be a by-phrase rather than a grammatical subject. I claim that this is possible in this variety of Spanish due to the emergence of a null pronoun, absent in other varieties of Spanish, that can merge in the specifier of Voice and restrict, rather than saturate, an agent argument, permitting the subsequent addition of a third-person by-phrase. I demonstrate that this analysis is able to explain its hybrid properties as well as other person restrictions on the by-phrases that express the agent. Finally, I describe avenues of future research that will help discern the role that language contact may have played in the emergence of A-P hybrids. Full article
(This article belongs to the Special Issue New Approaches to Spanish Dialectal Grammar)
14 pages, 13498 KB  
Article
Within-Document Arabic Event Coreference: Challenges, Datasets, Approaches and Future Direction
by Mohammed Aldawsari, Manjur Kolhar and Omer Salih Dawood Omer
Appl. Sci. 2023, 13(19), 11004; https://doi.org/10.3390/app131911004 - 6 Oct 2023
Cited by 3 | Viewed by 2115
Abstract
Event coreference resolution is a crucial component in Natural Language Processing (NLP) applications as it directly affects text summarization, machine translation, classification, and textual entailment. However, the research on this task for Arabic language is limited, compared to other languages such as English, [...] Read more.
Event coreference resolution is a crucial component in Natural Language Processing (NLP) applications as it directly affects text summarization, machine translation, classification, and textual entailment. However, the research on this task for Arabic language is limited, compared to other languages such as English, Chinese and Spanish. This paper aims to review the state-of-the-art approaches in event coreference (EC) within the context of coreference resolution tasks, emphasizing the significance of EC in NLP. The focus is placed on the latest developments in Arabic language processing related to event coreference. To fill this gap, a comprehensive study of existing work is conducted, and new approaches are suggested. The paper highlights the challenges specific to Arabic event coreference resolution, such as the variability of verb forms, pronoun ambiguity, ellipsis and null arguments, lexical and morphological variation, lack of annotated resources, discourse and pragmatic context, and cultural and contextual sensitivity. Addressing these challenges requires a deep understanding of Arabic linguistics, advanced NLP techniques, and the availability of annotated resources. Furthermore, this paper examines the existing datasets and methods for Arabic event coreference and proposes an annotation scheme. By leveraging existing NLP algorithms and developing event coreference resolution systems tailored for Arabic, the accuracy and performance of NLP tasks can be significantly improved. Full article
47 pages, 3134 KB  
Article
Number Morphology and Bare Nouns in Some Romance Dialects of Italy
by Cristina Guardiano, Michela Cambria and Vincenzo Stalfieri
Languages 2022, 7(4), 255; https://doi.org/10.3390/languages7040255 - 30 Sep 2022
Cited by 4 | Viewed by 3736
Abstract
This paper explores aspects of microvariation concerning the morphological realization of the feature Number within nominal structures in a selected subset of Romance dialects of Italy. First, the different strategies adopted in the dialects of the dataset for the realization of number alternations [...] Read more.
This paper explores aspects of microvariation concerning the morphological realization of the feature Number within nominal structures in a selected subset of Romance dialects of Italy. First, the different strategies adopted in the dialects of the dataset for the realization of number alternations on various nominal categories (nouns/adjectives, articles, demonstratives, and possessives) are presented. Then, the relation between the latter and the distribution of “bare” argument nominals (i.e., of nominal structures which, in argument position, occur without any lexicalized determiner) is explored. It will be observed that the distribution of bare arguments in the dialects of the dataset is consistent with the hypotheses made in the literature, which suggest that there is a correlation between the realization of number alternations on nouns and the possibility for “null” (i.e., unpronounced) determiners to be licensed. Full article
(This article belongs to the Special Issue New Perspectives on Italian Dialects)
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26 pages, 4510 KB  
Article
Time Reference in Mandarin Relative Clauses
by Hongyuan Sun and Hamida Demirdache
Languages 2022, 7(3), 170; https://doi.org/10.3390/languages7030170 - 5 Jul 2022
Cited by 1 | Viewed by 3236
Abstract
In this paper, we investigate constraints on the time reference of embedded clauses in Mandarin. We show that while English past-tensed embedded clauses disallow later-than-matrix readings in intensional contexts on a de dicto construal, Mandarin relative clauses with bare predicates yield temporally free [...] Read more.
In this paper, we investigate constraints on the time reference of embedded clauses in Mandarin. We show that while English past-tensed embedded clauses disallow later-than-matrix readings in intensional contexts on a de dicto construal, Mandarin relative clauses with bare predicates yield temporally free readings across the board. We argue that the contrast between the temporal interpretations of bare embedded clauses in Mandarin vs. past-tensed embedded clauses in English is not due to a putative contrast between ‘tenseless’ languages (as Mandarin is traditionally assumed to be) and ‘tensed’ languages such as English. Mandarin is indeed not tenseless, but rather has a covert Non-Future tense, restricting the reference time of bare sentences to non-future times. Moreover, Mandarin superficially tenseless embedded clauses with overt—be it perfect, perfective, durative/progressive—aspectual marking do not allow later-than-matrix readings on a de dicto construal, just like tensed embedded clauses in English. We conclude that the freedom of interpretation of bare embedded clauses in Mandarin cannot be imputed to null semantically underspecified tense, but rather to null semantically underspecified aspect. Our analysis provides, to our knowledge, the first arguments for Non-Future tense in embedded contexts. Full article
(This article belongs to the Special Issue Tense and Aspect Across Languages)
10 pages, 245 KB  
Article
Research Questions with PICO: A Universal Mnemonic
by Andreas Nishikawa-Pacher
Publications 2022, 10(3), 21; https://doi.org/10.3390/publications10030021 - 22 Jun 2022
Cited by 106 | Viewed by 30859
Abstract
A well-formulated research question should incorporate the components of a ‘problem’, an ‘intervention’, a ‘control’, and an ‘outcome’—at least according to the PICO mnemonic. The utility of this format, however, has been said to be limited to clinical studies that pose ‘which’ questions [...] Read more.
A well-formulated research question should incorporate the components of a ‘problem’, an ‘intervention’, a ‘control’, and an ‘outcome’—at least according to the PICO mnemonic. The utility of this format, however, has been said to be limited to clinical studies that pose ‘which’ questions demanding correlational study designs. In contrast, its suitability for descriptive approaches outside of clinical investigations has been doubted. This paper disagrees with the alleged limitations of PICO. Instead, it argues that the scheme can be used universally for every scientific endeavour in any discipline with all study designs. This argument draws from four abstract components common to every research, namely, a research object, a theory/method, a (null) hypothesis, and the goal of knowledge generation. Various examples of how highly heterogenous studies from different disciplines can be grounded in the single scheme of PICO are offered. The finding implies that PICO is indeed a universal technique that can be used for teaching academic writing in any discipline, beyond clinical settings, regardless of a preferred study design. Full article
23 pages, 379 KB  
Review
The Updated NICE Guidance Exposed the Serious Flaws in CBT and Graded Exercise Therapy Trials for ME/CFS
by Mark Vink and Alexandra Vink-Niese
Healthcare 2022, 10(5), 898; https://doi.org/10.3390/healthcare10050898 - 12 May 2022
Cited by 23 | Viewed by 12742
Abstract
The British National Institute for Health and Care Excellence (NICE) recently published its updated guidelines for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). NICE concluded, after an extensive review of the literature, that graded exercise therapy (GET) is harmful and should not be used, and [...] Read more.
The British National Institute for Health and Care Excellence (NICE) recently published its updated guidelines for myalgic encephalomyelitis/chronic fatigue syndrome (ME/CFS). NICE concluded, after an extensive review of the literature, that graded exercise therapy (GET) is harmful and should not be used, and that cognitive behavioural therapy (CBT) is only an adjunctive and not a curative treatment. Leading proponents of the cognitive behavioural model (CBmodel) find it difficult to accept this paradigm shift. In, for example, an article in The Lancet, they try to argue that the new NICE guideline is based on ideology instead of science. In this article we reviewed the evidence they used to support their claims. Our analysis shows that the trials they used in support suffered from serious flaws which included badly designed control groups, relying on subjective primary outcomes in non-blinded studies, including patients in their trials who didn’t have the disease under investigation or had a self-limiting disease, selective reporting, outcome switching and making extensive endpoint changes, which created an overlap in entry and recovery criteria, using a post-hoc definition of recovery which included the severely ill, not publishing results that contradict their own conclusion, ignoring their own (objective) null effect, etc. The flaws in these trials all created a bias in favour of the interventions. Despite all these flaws, treatments that are said to lead to recovery in reality do not lead to objective improvement. Therefore, these studies do not support the claim that CBT and GET are effective treatments. Moreover, the arguments that are used to claim that NICE was wrong, in reality, highlight the absence of evidence for the safety and efficacy of CBT and GET and strengthen the decision by NICE to drop CBT and GET as curative treatments for ME/CFS. Full article
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