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In this study, a classifier (hyperplane) is determined to distinguish the neural responses during emotion regulation versus viewing images in healthy adults and then applied to determine (i) the effectiveness of the emotion regulation response (defined as emotion regulation distance from the hyperplane [DFHER]) in independent samples of healthy adults, patients with BD, and the patients’ unaffected relatives (URs) and (ii) the association of DFHER with the duration of future (hypo)manic and depressive episodes for patients with BD over a 16-month follow-up period.
Methods
Study participants (N = 226) included 65 healthy adults (35 used for support vector machine [SVM] learning [HCTrain] and 30 kept as an independent test sample [HCTest]), 87 patients with newly diagnosed BD (67% BD type 2) and 74 URs. BOLD response data came from an emotion regulation task. Clinical symptoms were assessed at baseline fMRI and after 16 months of specialized treatment.
Results
The SVM ML analysis identified a hyperplane with 75.7% accuracy. Patients with BD showed reduced DFHER relative to the HCTest and UR groups. Reduced DFHER was associated with reduced improvement in psychosocial functioning during the 16-month follow-up time (B = −1.663, p = 0.02).
Conclusions
The neural response during emotion regulation can be relatively well distinguished in healthy adults via ML. Patients with newly diagnosed BD show significant disruption in the recruitment of this emotion regulation response. Disrupted may indicate a reduced capacity for functional improvement during specialized treatment in a mood disorder clinic.
Motor functional neurological disorder (FND) is a common illness associated with significant functional impairment. There are no effective pharmacotherapies, and despite the early promise of physiotherapy studies, many suffer disabling symptoms in the long term. There is a theoretical rationale for combining psychedelics with physiotherapy; however, the potential benefit of this approach and optimal treatment model remains unexplored. Here, we present the protocol for the first study investigating the tolerability, feasibility, and potential efficacy of two distinct treatment regimens of psilocybin-assisted physiotherapy for refractory motor FND: a moderate dose that incorporates movement tasks during the acute drug effects versus a standard dose alone.
Methods:
Twenty-four participants with refractory motor FND will be randomised in a 1:1 ratio to either (1) psilocybin 15mg, with movement tasks conducted during the acute drug effects; or (2) psilocybin 25mg alone. All participants will receive two sessions of FND-specific physiotherapy pre-dosing, six sessions of physiotherapy post-dosing, and undergo follow-up visits one week and four weeks following their final physiotherapy session. A battery of outcome measures will be completed as scheduled, assessing tolerability, feasibility, motor FND symptom severity, psychiatric and physical symptoms, quality of life, treatment expectations, intensity of the acute drug effects, personality, motor function, force-matching performance, resting-state and task-based brain imaging, and subjective experiences of the study treatment.
Discussion:
These findings will assist the design of an adequately powered randomised controlled trial in this cohort. The findings may also inform the feasibility of psychedelic treatment in related functional and neuropsychiatric disorders.
Paleontology provides insights into the history of the planet, from the origins of life billions of years ago to the biotic changes of the Recent. The scope of paleontological research is as vast as it is varied, and the field is constantly evolving. In an effort to identify “Big Questions” in paleontology, experts from around the world came together to build a list of priority questions the field can address in the years ahead. The 89 questions presented herein (grouped within 11 themes) represent contributions from nearly 200 international scientists. These questions touch on common themes including biodiversity drivers and patterns, integrating data types across spatiotemporal scales, applying paleontological data to contemporary biodiversity and climate issues, and effectively utilizing innovative methods and technology for new paleontological insights. In addition to these theoretical questions, discussions touch upon structural concerns within the field, advocating for an increased valuation of specimen-based research, protection of natural heritage sites, and the importance of collections infrastructure, along with a stronger emphasis on human diversity, equity, and inclusion. These questions offer a starting point—an initial nucleus of consensus that paleontologists can expand on—for engaging in discussions, securing funding, advocating for museums, and fostering continued growth in shared research directions.
The NHS 2025 Health Plan aims for radical reform but overlooks people with intellectual disability. This editorial highlights critical omissions in policy, services, research and rights protections. Without intentional inclusion, digital and community shifts risk deepening inequality. True progress demands co-produced strategies to ensure equitable care for this vulnerable population.
Hereditary hemorrhagic telangiectasia (HHT) is an autosomal dominant genetic disorder leading to vascular malformations in different organ systems. Approximately 10% of patients with HHT have brain vascular malformations (BVMs). Due to the negative health consequences related to BVMs, screening with MRI is recommended. There are no health jurisdictional standards for medical imaging protocols in North America or elsewhere. The objective of this project is to adopt a provincial standardized operating protocol (SOP) to improve diagnostic accuracy and reduce inappropriate imaging in patients with and without HHT in Alberta.
Methods:
Multiple fora were held among the five Alberta Health Services zones with stakeholders from urban, suburban and rural radiology groups, neurology, pulmonology and hematology. The consensus process took five years to complete between 2015 and 2020. The content of the fora was approved by all participants.
Results:
The SOP was implemented in February 2020 and defines that screening for BVMs must include standard unenhanced brain MRI (sagittal T1, axial fluid-attenuated inversion recovery and axial T2) with susceptibility-weighted imaging (SWI), a 3T or 1.5T magnet strength and minimum imaging standards to include 3 mm contiguous slice thickness.
Discussion:
Incorporation of SWI allowed for the elimination of MR contrast to improve access to the local performance of studies within the province, facilitating virtual care.
Conclusion:
A provincial SOP for BVM screening in patients with suspected or confirmed HHT was successfully implemented in Alberta. Gadolinium was avoided, as it was felt to be unnecessary for screening purposes and might complicate imaging at more remote sites.
The next-generation radio astronomy instruments are providing a massive increase in sensitivity and coverage, largely through increasing the number of stations in the array and the frequency span sampled. The two primary problems encountered when processing the resultant avalanche of data are the need for abundant storage and the constraints imposed by I/O, as I/O bandwidths drop significantly on cold storage. An example of this is the data deluge expected from the SKA Telescopes of more than 60 PB per day, all to be stored on the buffer filesystem. While compressing the data is an obvious solution, the impacts on the final data products are hard to predict. In this paper, we chose an error-controlled compressor – MGARD – and applied it to simulated SKA-Mid and real pathfinder visibility data, in noise-free and noise-dominated regimes. As the data have an implicit error level in the system temperature, using an error bound in compression provides a natural metric for compression. MGARD ensures the compression incurred errors adhere to the user-prescribed tolerance. To measure the degradation of images reconstructed using the lossy compressed data, we proposed a list of diagnostic measures, exploring the trade-off between these error bounds and the corresponding compression ratios, as well as the impact on science quality derived from the lossy compressed data products through a series of experiments. We studied the global and local impacts on the output images for continuum and spectral line examples. We found relative error bounds of as much as 10%, which provide compression ratios of about 20, have a limited impact on the continuum imaging as the increased noise is less than the image RMS, whereas a 1% error bound (compression ratio of 8) introduces an increase in noise of about an order of magnitude less than the image RMS. For extremely sensitive observations and for very precious data, we would recommend a $0.1\%$ error bound with compression ratios of about 4. These have noise impacts two orders of magnitude less than the image RMS levels. At these levels, the limits are due to instabilities in the deconvolution methods. We compared the results to the alternative compression tool DYSCO, in both the impacts on the images and in the relative flexibility. MGARD provides better compression for similar error bounds and has a host of potentially powerful additional features.
This study aims to discern similarities and differences associated with the impact of war on Ukrainian and Israeli women. We hypothesize that country affiliation significantly determines their mental health and psycho-emotional well-being. A total of 1,071 Ukrainian (N = 601) and Israeli (N = 470) women were surveyed online from September to December 2022 in Ukraine and November 2023 to March 2024 in Israel. Valid and reliable survey instruments were used to gather data about the fear of war, depression, loneliness, suicidal ideation and substance misuse. Fear of war and depression were higher among Israeli respondents. However, Ukrainian women reported more loneliness, substance use and psycho-emotional deterioration. Respondents from both countries did not show a different level of suicidal ideation. Two-way analysis of variance (ANOVA) results show fear of war associated with country and depression; and depression linked to country and increased alcohol use, especially among Ukrainian respondents. Comparative results partially confirm the study hypothesis. The impact of the war on Ukrainian and Israeli women has similar effects; however, differences exist that may be attributed to culture and adaptation to war length. Further research, including uniform data collection and analysis, is needed to determine the impact of war on women as well as their familial and work-related responsibilities that tend to increase during such conditions.
Most people with mental illness in low and middle-income countries (LMICs) do not receive biomedical treatment, though many seek care from traditional healers and faith healers. We conducted a qualitative study in Buyende District, Uganda, using framework analysis. Data collection included interviews with 24 traditional healers, 20 faith healers, and 23 biomedical providers, plus 4 focus group discussions. Interviews explored treatment approaches, provider relationships, and collaboration potential until theoretical saturation was reached. Three main themes emerged: (1) Biomedical providers’ perspectives on traditional and faith healers; (2) Traditional and faith healers’ views on biomedical providers; and (3) Collaboration opportunities and barriers. Biomedical providers viewed faith healers positively but traditional healers as potentially harmful. Traditional and faith healers valued biomedical approaches while feeling variably accepted. Interest in collaboration existed across groups but was complicated by power dynamics, economic concerns, and differing mental illness conceptualizations. Traditional healers and faith healers routinely referred patients to biomedical providers, though reciprocal referrals were rare. The study reveals distinct dynamics among providers in rural Uganda, with historical colonial influences continuing to shape relationships and highlighting the need for integrated, contextually appropriate mental healthcare systems.
The association between cannabis and psychosis is established, but the role of underlying genetics is unclear. We used data from the EU-GEI case-control study and UK Biobank to examine the independent and combined effect of heavy cannabis use and schizophrenia polygenic risk score (PRS) on risk for psychosis.
Methods
Genome-wide association study summary statistics from the Psychiatric Genomics Consortium and the Genomic Psychiatry Cohort were used to calculate schizophrenia and cannabis use disorder (CUD) PRS for 1098 participants from the EU-GEI study and 143600 from the UK Biobank. Both datasets had information on cannabis use.
Results
In both samples, schizophrenia PRS and cannabis use independently increased risk of psychosis. Schizophrenia PRS was not associated with patterns of cannabis use in the EU-GEI cases or controls or UK Biobank cases. It was associated with lifetime and daily cannabis use among UK Biobank participants without psychosis, but the effect was substantially reduced when CUD PRS was included in the model. In the EU-GEI sample, regular users of high-potency cannabis had the highest odds of being a case independently of schizophrenia PRS (OR daily use high-potency cannabis adjusted for PRS = 5.09, 95% CI 3.08–8.43, p = 3.21 × 10−10). We found no evidence of interaction between schizophrenia PRS and patterns of cannabis use.
Conclusions
Regular use of high-potency cannabis remains a strong predictor of psychotic disorder independently of schizophrenia PRS, which does not seem to be associated with heavy cannabis use. These are important findings at a time of increasing use and potency of cannabis worldwide.
In November 2023, the Department of Health and Social Care published guidance, entitled ‘Baroness Hollins’ Final Report: My Heart Breaks – Solitary Confinement in Hospital Has no Therapeutic Benefit for People with a Learning Disability and Autistic People’. The report's commendable analysis of the problems and identification of the areas where practice should be improved is unfortunately not matched by many of its recommendations, which appear to be contrary to evidence-based approaches. The concerns are wide-ranging, from the use of the term ‘solitary confinement’ for current long-term segregation (LTS) and seclusion, to presumption that all LTS and seclusion is bad, to holding clinicians (mainly psychiatrists) responsible for events beyond their locus of control. Importantly, there is a no guidance on how to practically deliver the recommendations in an evidence-based manner. This Feature critically appraises the report, to provide a comprehensive summary outlining potential positive impacts, identifying specific concerns and reflecting on best practice going forward.
We use a combination of primary and secondary data to investigate and quantify the impacts of the COVID-19 pandemic on the California specialty crop sector. We demonstrate that the specialty crop sector was highly resilient during the pandemic and aftermath in terms of output. For many crops, production fell somewhat between 2019 and 2021, but not to an extent that is outside of normal annual variation for fruits and vegetables. However, prices increased dramatically for many commodities. Contrary to conventional wisdom, most input costs did not surge during the pandemic, and some fell. But both the primary and secondary data identify labor and truck transportation as the major issues facing producers and driving up prices. Trade associations played a vital role in disseminating solutions to growers throughout the pandemic.
Fast and efficient identification is critical for reducing the likelihood of weed establishment and for appropriately managing established weeds. Traditional identification tools require either knowledge of technical morphological terminology or time-consuming image matching by the user. In recent years, deep learning computer vision models have become mature enough to enable automatic identification. The major remaining bottlenecks are the availability of a sufficient number of high-quality, reliably identified training images and the user-friendly, mobile operationalization of the technology. Here, we present the first weed identification and reporting app and website for all of Australia. It includes an image classification model covering more than 400 species of weeds and some Australian native relatives, with a focus on emerging biosecurity threats and spreading weeds that can still be eradicated or contained. It links the user to additional information provided by state and territory governments, flags species that are locally reportable or notifiable, and allows the creation of observation records in a central database. State and local weed officers can create notification profiles to be alerted of relevant weed observations in their area. We discuss the background of the WeedScan project, the approach taken in design and software development, the photo library used for training the WeedScan image classifier, the model itself and its accuracy, and technical challenges and how these were overcome.
Conservation aquaculture, defined as cultivating aquatic organisms to manage or replenish natural populations, has been advocated as a strategy to enhance fisheries production and help restore declining populations. Culture is especially compelling for species in steep decline and for which there is established methodology. The queen conch Aliger gigas is an example of a species with widely overexploited populations, with attempts to culture the species commercially ongoing for > 40 years. However, hatchery-releases have shown low survival from post-settlement to near maturity, leading to low conservation aquaculture potential. When this is viewed alongside large-scale fishery extractions, it is apparent that it is not commercially feasible to replace wild harvest nor ecologically feasible to replenish queen conch populations using existing aquaculture approaches. An age-based mortality model estimates the magnitude of culture required to replace a single adult of reproductive age. Extrapolations from catch–weight relationships highlight the scale of facilities and costs required to partially offset the harvest in a typical Caribbean fishery. Estimates of reproduction to achieve replacement suggest a greater yield from properly protecting natural breeding aggregations. Queen conch aquaculture is useful for scientific inquiry, community engagement and education, but not for stock enhancement or population restoration without more practical and cost-efficient options. Therefore, protecting breeding aggregations should be prioritized for the ecological viability of the species, as well as for its economic value for the people and industries that rely upon it.
The interplay between SARS-CoV-2 and contemporaneous bacterial or fungal culture growth may have crucial implications for clinical outcomes of hospitalized patients. This study aimed to quantify the effect of microbiological culture positivity on mortality among hospitalized patients with SARS-CoV-2.
Methods:
In this retrospective cohort study, we included adult hospitalized patients from OPTUM COVID-19 specific data set, who tested positive for SARS-CoV-2 within 14 days of hospitalization between 01/20/2020 and 01/20/2022. We examined outcomes of individuals with organisms growing on cultures from the bloodstream infections (BSIs), urinary tract, and respiratory tract, and a composite of the three sites. We used propensity score matching on covariates included demographics, comorbidities, and hospitalization clinical parameters. In a sensitivity analysis, we included same covariates but excluded critical care variables such as length of stay, intensive care unit stays, mechanical ventilation, and extracorporeal membrane oxygenation.
Results:
The cohort included 104,560 SARS-CoV-2 positive adult hospitalized patients across the United States. The unadjusted mortality odds increased significantly with BSIs (98.7%) and with growth on respiratory cultures (RC) (176.6%), but not with growth on urinary cultures (UC). Adjusted analyses showed that BSIs and positive RC independently contribute to mortality, even after accounting for critical care variables.
Conclusions:
In SARS-CoV-2-positive hospitalized patients, positive bacterial and fungal microbiological cultures, especially BSIs and RC, are associated with an increased risk of mortality even after accounting for critical care variables associated with disease severity. These findings underscore the importance of stringent infection control and the effective management of secondary infections to improve patient outcomes.
This contribution departs from an existing model, the Design Framework for Systems-of-Systems Resilience, to explore systems resilience issues across the health, environmental, and economic domains. The reported research activities include 1) a rapid review to collect a set of systems indicators and 2) a design workshop employing causal loop diagramming to map expected causal influences between indicators. Through this exercise, we examine key themes in this research domain and outline directions for further enquiry, while involving members of the design research community in an open dialogue.
Analyzing data from a national deidentified electronic health record-based data set using a matched case–control study design, we found that antibiotic use and severity of illness were independent risk factors for healthcare-associated candidemia in adult patients hospitalized with SARS-CoV-2 infection. Interleukin-6 inhibitor and corticosteroid use were not independent risk factors.
PET imaging is increasingly recognized as an important diagnostic tool to investigate patients with cognitive disturbances of possible neurodegenerative origin. PET with 2-[18F]fluoro-2-deoxy-D-glucose ([18F]FDG), assessing glucose metabolism, provides a measure of neurodegeneration and allows a precise differential diagnosis among the most common neurodegenerative diseases, such as Alzheimer’s disease, frontotemporal dementia or dementia with Lewy bodies. PET tracers specific for the pathological deposits characteristic of different neurodegenerative processes, namely amyloid and tau deposits typical of Alzheimer’s Disease, allow the visualization of these aggregates in vivo. [18F]FDG and amyloid PET imaging have reached a high level of clinical validity and are since 2022 investigations that can be offered to patients in standard clinical care in most of Canada.
This article will briefly review and summarize the current knowledge on these diagnostic tools, their integration into diagnostic algorithms as well as perspectives for future developments.
To assess the perceived benefits of a novel educational approach for otolaryngology trainees: a virtual reality temporal bone simulator drilling competition.
Methods
Regional otolaryngology trainees participated in the competition. Drilling activities using the Voxel-Man TempoSurg simulator were scored by experts. Questionnaires that contained questions covering motivators for attending, perceived learning and enjoyment were sent to participants. Agreement with statements was measured on a 10-point Likert scale (1 = strongly disagree, 10 = strongly agree).
Results
Eighteen trainees participated. The most cited reason for attending was for learning and/or education (61 per cent), with most attendees (72 per cent) believing that competition encourages more reading and/or practice. Seventeen attendees (94 per cent) believed Voxel-Man TempoSurg-based simulation would help to improve intra-operative performance in mastoidectomy (mean 7.83 ± 1.47, p < 0.001) and understanding of anatomy (mean 8.72 ± 1.13, p < 0.001). All participants rated the competition as ‘fun’ and 83 per cent believed the competitive element added to this.
Conclusion
The virtual reality temporal bone competition is a novel educational approach within otolaryngology that was positively received by otolaryngology trainees.