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The growing integration of artificial intelligence (AI) and patient-reported digital tools (ePROMs and ePREMs) in palliative care offers new opportunities for personalised care yet also raises profound ethical and philosophical concerns. This paper examines how emerging technologies intersect with the concept of human dignity at the end of life, proposing an expanded notion of post-biographical dignity.
Methods
Ethical-philosophical analysis based on critical readings of AI ethics, narrative medicine, and the philosophy of technology.
Results
While digital tools such as ePROMs and ePREMs offer potential for richer, more person-centred care, they also risk reducing patients to data points and predictive profiles. Digital processes increasingly shape the narrative, vulnerability, and memory of the dying person. Post-biographical dignity calls for a reconceptualization of care that includes memory, relational continuity, and ethical engagement with digital remains.
Significance of Results
End-of-life care in the age of AI must move beyond autonomy-focused ethics to encompass the narrative, relational, and posthumous dimensions of dignity. A critical, philosophically informed ethics is essential to prevent depersonalisation in digitally mediated care.
Generalized myasthenia gravis (gMG) is a chronic neuromuscular disease that causes muscle weakness and fatigue, severely impairing quality of life. Efgartigimod is a novel drug that is recently approved for treatment of acetylcholine receptor antibody-positive (AChR-Ab+) gMG patients in Canada. In clinical practice, it is expected to be used in AChR-Ab+ gMG patients who continue to experience symptoms despite conventional therapy and primarily replace chronic immunoglobulins.
Methods:
A Markov model was developed to estimate costs and benefits (measured as quality-adjusted life years [QALYs]) of efgartigimod and chronic immunoglobulins for AChR-Ab+ gMG patients. The analysis was conducted from the perspective of the Canadian publicly funded healthcare system over a lifetime horizon. The model comprised six health states based on Myasthenia Gravis Activities of Daily Living (MG-ADL) scores: MG-ADL < 5, MG-ADL 5–7, MG-ADL 8–9, MG-ADL ≥ 10, myasthenic crisis or death. Health state transition probabilities were estimated from the ADAPT and ADAPT+ studies, plus a network meta-analysis that compared efgartigimod against chronic immunoglobulins. The MyRealWorld MG study informed utility values. Modeled costs included treatment and administration, disease monitoring, complications from chronic corticosteroid use, exacerbation/crisis management, adverse events and end-of-life care.
Results:
Over a lifetime horizon, efgartigimod and chronic immunoglobulins were predicted to have total discounted QALYs of 16.80 and 13.35 and total discounted costs of $1,913,294 and $2,170,315, respectively. Efgartigimod dominated chronic immunoglobulins with incremental QALYs of 3.45 and cost savings of $257,020.
Conclusions:
Efgartigimod provides greater benefit in terms of lower costs than chronic immunoglobulins for AChR-Ab+ gMG patients in Canada.
Loneliness is associated with several physical and mental health problems, yet its costs to the healthcare system remain unclear.
Aims
The current study aimed to review literature on the health and social care impacts of loneliness, and review economic evaluations of loneliness interventions.
Method
We conducted a systematic review of studies published from 2008 to April 2025 by searching five bibliographic databases, grey literature and reference lists of systematic reviews. Studies estimating health and social care cost/expenditure, and on health resource utilisation, were included to assess the impact of loneliness on the health system. Return on investment, social return on investment and cost-effectiveness evaluations were included to assess the economic impact of loneliness interventions. We conducted quality appraisal and narrative synthesis of results.
Results
We included 53 studies. Eight estimated the healthcare cost/expenditure of loneliness, 33 reported healthcare resource use and 19 were economic evaluations of interventions. Findings relating to the cost/expenditure of loneliness and service use were inconsistent: some studies reported excess costs/expenditure and service use, whereas others found lower costs/expenditure and service use. Economic evaluation studies indicated that loneliness interventions can be cost-effective, but were not consistently cost-saving or effective in reducing loneliness.
Conclusions
Findings on the impact of loneliness on the healthcare system and economic evaluations of loneliness interventions were varied. Therefore, we cannot derive confident conclusions from this review. To address evidence gaps, future research relating to social care, younger populations, direct healthcare costs of loneliness and randomised controlled trials with long-term follow-ups should be prioritised.
The main objective of this study was to analyse the changes of taxonomic, functional and phylogenetic diversities shown by bird assemblages at two contrasting vegetational types in Southern Mexico. Our main hypothesis was that we would find a higher diversity in Tropical Dry Forest (TDF) than in Oak Woodland (OW) due to a monotonic decrease in diversity with altitude. During eleven months, we surveyed both vegetation types to record bird species and abundances. We established points and simultaneously carried out 5-minutes count and soundscape recordings. We quantified our sampling effort by means of the sample coverage and calculated Hill numbers to express alpha and beta diversities. Contrary to our expectations, in terms of alpha taxonomic and functional diversities, the OW had consistently higher values than the TDF. After accounting for abundance data, we found a marked decrease in phylogenetic and taxonomic beta diversity, but an increase in functional diversity compared to the presence/absence matrix. The low beta phylogenetic diversity combined with the high beta functional diversity suggests that a small set of closely related species could have evolved in the dry slopes of the area, and by the action of niche differentiation developed different functional traits. The high functional beta diversity indicates a high complementarity between the avifaunas of each vegetation type, which is relevant in terms of conservation.
Insight assessment in psychosis remains challenging in practice-oriented research.
Aims
To develop and validate a proxy measure for insight based on information from electronic health records (EHR). For that purpose, we used data on the Scale to Assess Unawareness of Mental Disorder (SUMD) and data from EHR notes of patients in an early psychosis intervention programme (Programa de Atención a Fases Iniciales de Psicosis, Santander, Spain).
Method
Junior and senior clinicians examined 134 clinical notes from 106 patients to explore criterion and content validity between SUMD and a clinician-rated proxy measure, using three SUMD items.
Results
In terms of criterion validity, SUMD scores correlated with the proxy (r = 0.61, P < 0.001), even after adjusting for the following confounders: type of psychotic disorder, clinical remission status and rater experience (r = 0.58, P < 0.001); and the proxy predicted good insight status (odds ratio 20.95, 95% CI 7.32–59.91, P < 0.001). Regarding content validity, the three main SUMD subscores correlated with the proxy (r = 0.55–0.60, P < 0.005). There were no significant differences in age, gender or other clinical variables, i.e. discriminant validity, and the proxy significantly correlated with validated psychometric instruments, i.e. external validity. Intraclass correlation coefficient (i.e. interrater reliability) was 0.88 (95% CI 0.59–1.00, P < 0.05).
Conclusions
This SUMD-based proxy measure was shown to have good to excellent validity and reliability, which may offer a reliable and efficient alternative for assessing insight in real-world clinical practice, EHR-based research and management. Future studies should explore its applicability across different healthcare contexts and its potential for automation, using natural language-processing techniques.
Non-suicidal self-injury (NSSI) is associated with mental disorders, yet work regarding the direction of this association is inconsistent. We examined the prevalence, comorbidity, time–order associations with mental disorders, and sex differences in sporadic and repetitive NSSI among emerging adults.
Methods
We used survey data from n = 72,288 first-year college students as part of the World Mental Health-International College Student Survey Initiative (WMH-ICS) to explore time–order associations between onset of NSSI and mental disorders, based on retrospective age-of-onset reports using discrete-time survival models. We distinguished between sporadic (1–5 lifetime episodes) and repetitive (≥6 lifetime episodes) NSSI in relation to DSM-5 mood, anxiety, and externalizing disorders.
Results
We estimated a lifetime NSSI rate of 24.5%, with approximately half reporting sporadic NSSI and half repetitive NSSI. The time–order associations between onset of NSSI and mental disorders were bidirectional, but mental disorders were stronger predictors of the onset of NSSI (median RR = 1.94) than vice versa (median RR = 1.58). These associations were stronger among individuals engaging in repetitive rather than sporadic NSSI. While associations between NSSI and mental disorders generally did not differ by sex, repetitive NSSI was a stronger predictor for the onset of subsequent substance use disorders among females compared to males. Most mental disorders marginally increased the risk for persistent repetitive NSSI (median RR = 1.23).
Conclusions
Our findings offer unique insights into the temporal order between NSSI and mental disorders. Further work exploring the mechanism underlying these associations will pave the way for early identification and intervention of both NSSI and mental disorders.
Volcanic monitoring in Antarctica provides dual benefits by facilitating the study of highly volcanically active yet underexplored regions and by serving as an essential tool for maintaining the safety of both national and international Antarctic bases. Deception Island, one of the most volcanically active areas on the Antarctic continent, is now equipped with an enhanced monitoring system, modernized by the Spanish National Geographic Institute (IGN), which assumed its management in September 2020, pursuant to a protocol established between the Spanish Ministry of Transport, Mobility, and Urban Agenda and Ministry of Science and Innovation. In order to meet the challenging conditions of the polar region, six permanent stainless-steel shelters have been installed over the course of the last four Spanish Antarctic campaigns. Each shelter is outfitted with batteries, solar panels, Wi-Fi and data acquisition systems for seismic and Global Navigation Satellite System (GNSS) stations. This monitoring network also comprises a station dedicated to measuring temperature within a thermal located where there is the anomaly on the island, a visual surveillance camera, seven seismic stations and six GNSS stations. All data collected are transmitted in real time to IGN headquarters in Madrid through Gabriel de Castilla Base, operated by the Spanish Army. Due to the growing volume of recorded data, it became necessary to upgrade transmission systems, leading to the installation of a next-generation satellite telemetry system during the 2023–2024 campaign. All seismic information is continuously and immediately analysed by the IGN’s National Seismic Network and is stored at the National Polar Data Center, housed within the Marine Technical Unit of the Spanish National Research Council, in accordance with the guidelines of the Spanish Polar Committee. The establishment of this infrastructure on Deception Island delivers a robust operational model that can be replicated in other polar settings, thereby contributing to the advancement of volcanic monitoring across the continent.
Predation is a strong driver of prey behaviour and sympatric species are likely exposed to similar selective predatory pressures. We test the hypothesis that this leads to similar anti-predator behaviours using the widespread Neotropical snake tribe Pseudoboini as our model. We reviewed and compiled documented defensive behaviours for all species, adding new unreported behaviours for three species. We used a cluster analysis to generate a matrix of defensive behaviour dissimilarity between species. We then used a phylogenetic generalized linear mixed model to test how behaviour dissimilarity changed with geographical overlap, similarity in ecological traits, and phylogenetic relatedness. Only 41 species had available data on defensive behaviour, with only 22 of those represented in the phylogeny. We found that similarity in defensive behaviour is significantly (albeit not strongly) correlated with geographical overlap, but only for species with similar body sizes. Phylogenetic relatedness by itself was a poor predictor of behaviour dissimilarity. This corroborates our hypothesis that defensive behaviours are spatially structured at larger scales but that this can be modulated by morphological differences. Testing inter-species ecogeographical differences of defensive behaviour and its implications can be broadly applied to other taxa.
A newly discovered grave in Wadi Nafūn, Oman, features a unique burial structure, combining monumental architecture and the collective deposition of human remains from multiple Neolithic groups. Detailed analysis of the burial community reveals new insights into Neolithic rituals and subsistence strategies during the Holocene Humid Period in southern Arabia.
In this retrospective study, critically ill patients with community-acquired pneumonia frequently received empiric anti-methicillin-resistant Staphylococcus aureus (MRSA) and antipseudomonal antibiotics despite having few or no guidelines-endorsed risk factors. De-escalation of anti-MRSA therapy was quicker, likely aided by MRSA polymerase chain reaction assays.
Current political developments worldwide illustrate that research on democratic backsliding is as important as ever. A recent exchange in Political Science & Politics (February 2024) highlighted again that the measurement of democracy remains a challenge. With many democracy indicators consisting of subjective assessments rather than factual observations, trends in democracy over time could be due to human biases in the coding of these indicators rather than empirical facts. This article leverages two cutting-edge Large Language Models (LLMs) for the coding of democracy indicators from the V-Dem project. With access to huge amounts of information, these models may be able to rate the many “soft” characteristics of regimes at substantially lower costs. Whereas LLM-generated codings largely align with expert coders for many countries, we show that when these models deviate from human assessments, they do so in different but consistent ways. Some LLMs are too pessimistic and others consistently overestimate the democratic quality of these countries. Although the combination of the two LLM codings can alleviate this concern, we conclude that it is difficult to replace human coders with LLMs because the extent and direction of these attitudes is not known a priori.
We present a versatile framework that employs Physics-Informed Neural Networks (PINNs) to discover the entropic contribution that leads to the constitutive equation for the extra-stress in rheological models of dilute polymer solutions. In this framework the training of the neural network is guided by an evolution equation for the conformation tensor, which is GENERIC-compliant. We compare two training methodologies for the data-driven PINN constitutive models: one trained on data from the analytical solution of the Oldroyd-B (OB) model under steady-state rheometric flows (PINN-rheometric), and another trained on in silico data generated from computational fluid dynamics (CFD) simulations of complex flow around a cylinder that use the OB model (PINN-complex). The capacity of the PINN models to provide good predictions is evaluated by comparison with CFD simulations using the underlying OB model as a reference. Both models are capable of predicting flow behaviour in transient and complex conditions; however, the PINN-complex model, trained on a broader range of mixed-flow data, outperforms the PINN-rheometric model in complex flow scenarios. The geometry agnostic character of our methodology allows us to apply the learned PINN models to flows with topologies different from those used for training.
This study reports on a set of experiments designed to clarify the impact of the rotational transform on confinement quality at the TJ-II stellarator. For this purpose, the net plasma current is controlled using external coils, resulting in the modification of the rotational transform profile. Significant and systematic variations of the edge electron density gradients (up to $50\,\%{-}60\,\%$) and the plasma energy content ($20\,\%{-}30\,\%$) are achieved. The explanation of this behaviour relies on the placement of low-order rational surfaces in relation to the edge gradient region, which affect local turbulence fluctuation levels, facilitating the formation of zonal flows and concomitant transport barriers. This hypothesis is confirmed experimentally on the basis of a broad array of diagnostic measurements. Calculations based on a resistive magnetohydrodynamic turbulence model provide qualitative support for this hypothesis, clarifying the impact on confinement of specific rational surfaces and highlighting the complex nature of magnetically confined fusion plasmas.
Consumer demand for pastured poultry continues to increase, but production is challenged by high feed costs. Increasing poultry use of pasture resources, including pasture plants and insects, could help offset feed costs, but few studies describe management strategies to increase poultry pasture use. Here, we introduced broiler chickens (broilers hereafter) to cover crop pastures over three growing seasons and assessed the impact of stocking density, sex, short-term feed restriction, and breed on diet diversity. Throughout each experiment, we quantified pasture use by measuring the diet richness of pasture plants and arthropods through DNA metabarcoding of broiler excreta. We found that pastured broilers consumed many cover crop and weed plant families, but the diet richness of insects was unexpectedly low. Lower stocking density increased diet richness across all 3 years of the study. A short-term feed restriction increased diet richness compared to an unrestricted feed treatment. For fast-growing broilers, individuals with greater weight gain consumed the greatest diversity of diet items; however, the opposite pattern was observed for slow-growing broilers. As expected from anecdotal evidence, slow-growing broilers tended to have higher diet richness compared to fast-growing broilers. Despite increased diet richness, stocking density and short-term feed restriction did not increase the feed-use efficiency (weight gain/feed consumed) of broilers. Further, slow-growing broilers had lower feed-use efficiency compared to fast-growing broilers. This study marks the first application of DNA metabarcoding to elucidate the dietary composition of pasture-raised broilers. Future research should expand on optimal rates of access to pasture, supplemental feed, and breed selection to maximize the cost-effectiveness of pastured poultry production.
This multisociety infection prevention guidance document was developed for individuals and organizations that engage in sterilization or high-level disinfection (HLD). It was endorsed by SHEA, APIC, ASGE, IDSA, and SGNA. This guidance is based on a synthesis of published scientific evidence, theoretical rationale, current practices, practical considerations, writing group consensus, and consideration of potential harm when applicable. The supplementary material includes a summary of recommendations. The guidance provides an overview of the Spaulding Classification and considerations around manufacturers’ instructions for use (MIFUs). Its recommendations address: point-of-use treatment prior to sterilization or HLD, preparation of reusable medical devices at the location of processing, sterilization, and immediate use steam sterilization (IUSS), HLD of lumened and non-lumened devices, processing of reusable medical devices used with lubricating or defoaming agents, monitoring for effectiveness of processing, handling of devices after HLD, augments and alternatives to HLD, processing of investigational devices, tracking of reusable medical devices, and approaches to implementation.
Objectives/Goals: To assess the impact of the MATCH Program on mentees and mentors over the years, we have surveyed both groups on the effectiveness of the mentorship process, how the MATCH program influenced mentees’ future career plans, and their ongoing interest in clinical research. Methods/Study Population: To evaluate impact on mentees and mentors in the most recent cycle, we fielded two program evaluation surveys, for mentors and mentees. The surveys were distributed and collected using Qualtrics in May 2024. The mentee survey collected data on relationship with mentors, quality of mentorship, future career/education plans, and self-assessment of the program impact. The mentor survey collected data on relationship with mentees, mentees’ engagement, and a self-assessment of the program impact. Qualitative analysis was conducted to determine key themes expressed by participants. The responses were compared to assess the effectiveness of the mentoring relationship from both parties. Results/Anticipated Results: Respondents included 15/20 (75%) mentees and 15/20 (75%) mentors. All mentees (100%) and mentors (100%) stated they would like to continue their relationship outside of the program. The majority of mentees 13/15 (87%) and mentors 13/25 (87%) also viewed their mentee/mentor relationship to be excellent or good. Most mentors 10/15 (67%) stated it was their first time serving as a mentor for the program. Mentees also found their experience in the program very beneficial with 6/15 (40%) stating that MATCH changed their career plans. In addition, most mentees 14/15 (93%) indicated that they are community college or four-year college/university bound. Most mentees 11/15 (73%) indicated an interest in pursuing a health or medical career. Also, 10/15 (67%) mentees stated an interest in pursuing a career in research. Discussion/Significance of Impact: Both mentees and mentors have benefited from the program’s daisy chain mentoring and the program has helped facilitate a potential lifelong mentorship between mentees and mentors. The program also demonstrates promise of developing a pre-health pathway for historically underrepresented students in STEM.
The nature and extent of interactions between the distant regions and cultures of Mesoamerica remain open to much debate. Close economic and political ties developed between Teotihuacan and the lowland Maya during the Early Classic period (AD 250–550), yet the relationship between these cultures continues to perplex scholars. This article presents an elaborately painted altar from an elite residential group at the lowland Maya centre of Tikal, Guatemala. Dating to the fifth century AD, the altar is unique in its display of Teotihuacan architectural and artistic forms, adding to evidence not only for cultural influence during this period, but also for an active Teotihuacan presence at Tikal.
Suicidal thoughts and behaviors (STBs) are a major concern in people with psychotic disorders. There is a need to examine their prevalence over long-term follow-up after first-episode psychosis (FEP) and determine their early predictors.
Methods
Of 510 participants with FEP evaluated on 26 risk factors for later outcomes, 260 were reassessed after 21 years of follow-up for lifetime ratings of most severe suicidal ideation, number of suicide attempts, and lethality of the most severe attempt. Risk factors and STB outcomes were modeled using hierarchical linear regression analysis.
Results
Over the 21-year follow-up period, 62.7% of participants experienced suicidal thoughts, 40.8% attempted suicide, and 18 died of suicide (3.5% case fatality and 20.6% proportionate mortality). Suicidal ideation was independently predicted by parental socioeconomic status, familial load of major depression, neurodevelopmental delay, poor adolescence social networks, and suicidal thoughts/behavior at FEP. The number of suicide attempts was independently predicted by years of follow-up, familial load of major depression, obstetric complications, childhood adversity, and suicidal thoughts/behavior at FEP. Lethality was independently predicted by familial load of major depression, male sex, neurodevelopmental delay, and poor adolescence social networks. The proportion of variance in suicidal ideation, attempts, and lethality explained by the independent predictors was 29.3%, 21.2%, and 18.1%, respectively.
Conclusions
STBs are highly prevalent in psychotic disorders and leads to substantial morbidity and mortality. They were predicted by a number of early risk factors, whose clinical recognition should contribute to improved prediction and prevention in people with psychotic disorders.