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Mild cognitive impairment with Lewy bodies (MCI-LB) may be identified prospectively based on the presence of cognitive impairment and several core clinical features (visual hallucinations, cognitive fluctuations, parkinsonism, and REM sleep behavior disorder). MCI-LB may vary in its presenting features, which may reflect differences in underlying pathological pattern, severity, or comorbidity.
We aimed to assess how clinical features of MCI-LB accumulate over time, and whether this is associated with the rate of cognitive decline.
Methods
In this cohort study, 74 individuals seen with MCI-LB prospectively underwent repeated annual cognitive and clinical assessment up to nine years. Relationships between clinical features (number of core features present and specific features present) and cognitive change on the Addenbrooke’s Cognitive Examination–Revised (ACE-R) were examined with time-varying mixed models. The accumulation of core clinical features over time was examined with a multi-state Markov model.
Results
When an individual with MCI-LB endorsed more clinical features, they typically experienced a faster cognitive decline (ACE-R Score Difference β = −1.1 [−1.7 to −0.5]), specifically when experiencing visual hallucinations (β = −2.1 [−3.5 to −0.8]) or cognitive fluctuations (β = −3.4 [−4.8 to −2.1]).
Individuals with MCI-LB typically acquired more clinical features with the passage of time (25.5% [20.0–32.0%] one-year probability), limiting the prognostic utility of baseline-only features.
Conclusions
The clinical presentation of MCI-LB may evolve over time. The accumulation of more clinical features of Lewy body disease, in particular visual hallucinations and cognitive fluctuations, may be associated with a worse prognosis in clinical settings.
Multilinguals face greater challenges than monolinguals in speech perception tasks, such as processing noisy sentences. Factors related to multilinguals’ language experience, such as age of acquisition, proficiency, exposure and usage, influence their perceptual performance. However, how language experience variability modulates multilinguals’ listening effort remains unclear. We analyzed data from 92 multilinguals who completed a listening task with words and sentences, presented in quiet and noise across participants’ spoken languages (Arabic, Hebrew and English). Listening effort was assessed using pupillometry. The results indicated higher accuracy and reduced effort in quiet than in noise, with greater language experience predicting better accuracy and reduced effort. These effects varied by stimulus and listening condition. For single words, greater language experience most strongly reduced effort in noise; for sentences, it had a more pronounced effect in quiet, especially for high-predictability sentences. These findings emphasize the importance of considering language experience variability when evaluating multilingual effort.
We consider a stochastic model, called the replicator coalescent, describing a system of blocks of k different types that undergo pairwise mergers at rates depending on the block types: with rate $C_{ij}\geq 0$ blocks of type i and j merge, resulting in a single block of type i. The replicator coalescent can be seen as a generalisation of Kingman’s coalescent death chain in a multi-type setting, although without an underpinning exchangeable partition structure. The name is derived from a remarkable connection between the instantaneous dynamics of this multi-type coalescent when issued from an arbitrarily large number of blocks, and the so-called replicator equations from evolutionary game theory. By dilating time arbitrarily close to zero, we see that initially, on coming down from infinity, the replicator coalescent behaves like the solution to a certain replicator equation. Thereafter, stochastic effects are felt and the process evolves more in the spirit of a multi-type death chain.
This study aimed to evaluate the general practitioner (GP) referral pathway for adult attention deficit hyperactivity disorder (ADHD) devised by the Irish Health Service Executive’s (HSE) National Clinical Programme for Adult ADHD (NCPAA). Primary objectives were to (i) quantify GP referrals to community mental health teams (CMHTs) for adult ADHD screening, (ii) measure workload on CMHTs related to screening adult ADHD referrals without comorbid mental health problems, and (iii) quantify access to adult ADHD screening through CMHTs and subsequent assessment and treatment access through specialist adult ADHD teams.
Methods:
An observational cohort design was used to retrospectively analyse ADHD-related referral data collected by clinical staff across 11 Irish CMHTs, and three specialist adult ADHD teams from January to December 2023.
Results:
There was high variability in adult ADHD referrals to CMHTs, ranging from 14 to 122 over one year. There was also high variability in the number of referrals seen by CMHTs, ranging from 9 to 82. From 304 referrals seen across 11 CMHTs, 25.3% required initial treatment for another mental health condition. Specialist adult ADHD teams received 3–4 times more referrals than they were able to assess during this timeframe.
Conclusions:
The NCPAA has provided crucial services for adults with ADHD in Ireland. However, an increase in neurodiversity awareness and demand for services suggests that a range of referral pathways depending on complexity level may be required. Alternative models are proposed, which require allocation of resources and training through primary care, secondary mental health services and specialist teams.
In early January 2025, wildfires swept through several regions of Los Angeles, California. The fires’ proximity to Hollywood, the epicentre of Western visual and cinematic production, led to the creation and wide circulation of real and artificially generated images on social media. In this article, I argue two things: first, these images capture human concerns in the age of polycrisis; and second, by interpreting these images as symptoms of an attempt to articulate a sense of reality in which human imagination has itself become under threat, public humanists of the present and future need to be attuned to their role as mediators of diverse publics and their way of making sense under these crisis conditions. This article thus uses selected imagery of Los Angeles’s wildfires circulating on social media to excavate how ways of meaning-making in a digital age (memeification, use of generative artificial intelligence) reflect real public concerns about polycrisis, rendering these images productive beyond their satirical or misinforming values.
Scholars and policymakers bemoan an imperial presidency in the war powers context, where the unilateral use of force is frequently interpreted as evidence of an unconstrained executive. Focusing on the strong blame avoidance incentives faced by politicians in the military intervention setting, I develop a model of the war powers focused on “Loss Responsibility Costs.” It suggests that presidents only risk full-scale war when they have the political cover provided by formal authorization, which forces lawmakers to share responsibility. Smaller interventions, in contrast, are frequently undertaken unilaterally because having the president act alone is consistent with congressional preferences for blame avoidance. Novel sentiment data based on tens of thousands of congressional speeches supports the claim that when the president acts unilaterally, they almost always act alongside lawmaker support, who favor intervention but avoid formally endorsing the endeavor. Altogether, it suggests legislators’ influence over war is stronger than commonly appreciated.
Male genital schistosomiasis (MGS), a gender-specific manifestation of urogenital schistosomiasis and neglected tropical disease, typically results from the entrapment of Schistosoma haematobium eggs within the male genital tract. Across the world, there are no current and accurate estimates of the burden of MGS, due to disease underreporting primarily from diagnostic challenges and a lack of general awareness within the health system. Diagnostic methods for MGS are extremely limited. Conventionally, semen microscopy for Schistosoma ova is used though this technique suffers from low sensitivity and lacks protocol standardization. The introduction of molecular diagnostics, such as polymerase chain reaction (PCR), has partly helped overcome this challenge of low sensitivity, though may not be suitable for use in resource-constrained settings. To address these challenges, in this review, we propose a two-step diagnostic algorithm for MGS in accordance with recent WHO guidelines, consisting of a high sensitivity serological test followed by a high specificity test (microscopy or molecular assay, dependent on setting). Further investigation is required into standardization of sample collection, processing, storage, and analysis in order to identify an evidence-based optimal diagnostic pipeline. New diagnostic tools are needed such as isothermal molecular assays, alongside optimization for semen analysis, which may alleviate barriers to diagnosis and present opportunities for integration with other sexual and reproductive health screening. These areas of future investigation underpin the development of a suitable diagnostic pipeline, as the continued neglect of MGS and its underdiagnosis presents a threat to the goal of elimination of schistosomiasis as a public health problem.
Much research has assessed methods of pain control for cattle castration, but there remains a lack of consensus regarding best practice. We conducted a systematic review and meta-analysis of published research including both an untreated control (i.e. castrated without pain mitigation) and at least one unimodal or multimodal analgesia treatment (i.e. castrated with a local anaesthetic alone, or in combination with a non-steroidal anti-inflammatory drug) to summarise findings on castration pain management. Studies were included if they castrated by surgery, elastration or crushing, and reported at least one of the following outcomes: cortisol, change in bodyweight, foot stomping, wound licking, a subjective assessment of pain using a visual analogue scale, or stride length. Our search identified 383 publications, of which 17 were eligible for inclusion. Most publications focused on surgical castration (n = 14), and the most frequently reported outcome was blood cortisol (n = 13). None of the included studies were assessed as having a low risk of bias, mostly due to a lack of reporting blinding procedures and reasons for missing data. Using a three-level random effect model, we concluded that multimodal analgesia reduced blood cortisol concentrations in the first hour following surgical castration in comparison to the control group; this effect was diminished but still evident at 3 and 4 h, but not beyond at 6, 12 and 24 h. Too few data were available to meaningfully assess other outcomes and methods. Variability in methods and outcomes between studies, and risks of bias, hinder our capacity to provide science-based recommendations for best practice.
A dual scaling of the second-order scalar structure function $\overline {{(\delta \theta )}^2}$, i.e. a scaling based on the Batchelor–Kolmogorov scales $\theta _B$, $\eta$ and another based on $\theta '$, $L$, representative of the large-scale motion, is examined in the context of the transport equation for $\overline {{(\delta \theta )}^2}$. Direct numerical simulation data over a relatively wide range of the Taylor microscale Reynolds number $Re_\lambda$ and a Schmidt number of order 1 in statistically stationary homogeneous isotropic turbulence with a uniform mean scalar gradient are used. It is observed that as $Re_\lambda$ increases, a dual scaling appears to emerge, where the scaling based on $\theta '$, $L$ extends to increasingly smaller values of $r/L$, where $r$ is the separation associated with the increment $ {{\delta \theta }}$, while the scaling based on $\theta _B$, $\eta$ extends to increasingly larger values of $r/\eta$. This suggests that both scalings should eventually overlap over a range of scales as $Re_\lambda$ continues to increase. Further, it is shown that such a dual scaling leads to the power-law relation $\overline {{(\delta \theta )}^2} \sim r^{\zeta _2}$, where $\zeta _2=2/3$ in the overlap region. The use of an empirical model for the local slope of $\overline {{(\delta \theta )}^2}$ (i.e. $\zeta _2$) shows that a value of $Re_\lambda$ of order $10^4$ is required for the slope to first reach the value $2/3$. Clearly, values larger than $10^4$ will be required before a $r^{2/3}$ inertial range is established.
Let E be an elliptic curve defined over ${{\mathbb{Q}}}$ which has good ordinary reduction at the prime p. Let K be a number field with at least one complex prime which we assume to be totally imaginary if $p=2$. We prove several equivalent criteria for the validity of the $\mathfrak{M}_H(G)$-property for ${{\mathbb{Z}}}_p$-extensions other than the cyclotomic extension inside a fixed ${{\mathbb{Z}}}_p^2$-extension $K_\infty/K$. The equivalent conditions involve the growth of $\mu$-invariants of the Selmer groups over intermediate shifted ${{\mathbb{Z}}}_p$-extensions in $K_\infty$, and the boundedness of $\lambda$-invariants as one runs over ${{\mathbb{Z}}}_p$-extensions of K inside of $K_\infty$.
Using these criteria we also derive several applications. For example, we can bound the number of ${{\mathbb{Z}}}_p$-extensions of K inside $K_\infty$ over which the Mordell–Weil rank of E is not bounded, thereby proving special cases of a conjecture of Mazur. Moreover, we show that the validity of the $\mathfrak{M}_H(G)$-property sometimes can be shifted to a larger base field K′.
Squamous cell carcinoma of the external auditory canal is rare, with bilateral cases even rarer. We report the management of a patient with bilateral external auditory canal squamous cell carcinoma related to radiotherapy and immunosuppression.
Case report
A 47-year-old woman with a history of radiotherapy 14 years prior and renal transplantation 6 years prior presented with bilateral external auditory canal squamous cell carcinoma. Squamous cell carcinoma was excised with a purely surgical approach. The two operations included a tympanic membrane graft to preserve hearing on the left side. The patient remains disease-free six months post-op. She uses a bone-conduction hearing aid to good effect on the right side and has mild hearing loss on the left. The operative areas have healed well.
Discussion
The patient’s previous radiotherapy and immunosuppression may have contributed to her bilateral external auditory canal squamous cell carcinoma. Preventative positron emission tomography scans have the potential to identify second malignancies early, allowing more conservative treatment plans.
Oscillations of a heated solid surface in an oncoming fluid flow can increase heat transfer from the solid to the fluid. Previous studies have investigated the resulting heat transfer enhancement for the case of a circular cylinder undergoing translational or rotational motions. Another common geometry, the flat plate, has not been studied as thoroughly. The flat plate sheds larger and stronger vortices that are sensitive to the plate’s direction of oscillation. To study the effect of these vortices on heat transfer enhancement, we conduct two-dimensional numerical simulations to compute the heat transfer from a flat plate with different orientations and oscillation directions in an oncoming flow with Reynolds number 100. We consider plates with fixed temperature and fixed heat flux, and find large heat transfer enhancement in both cases. We investigate the effects of the plate orientation angle and the plate oscillation direction, velocity, amplitude and frequency, and find that the plate oscillation velocity and direction have the strongest effects on global heat transfer. The other parameters mainly affect the local heat transfer distributions through shed vorticity distributions. We also discuss the input power needed for the oscillating-plate system and the resulting Pareto optimal cases.
The cyclicity and Koblitz conjectures ask about the distribution of primes of cyclic and prime-order reduction, respectively, for elliptic curves over $\mathbb {Q}$. In 1976, Serre gave a conditional proof of the cyclicity conjecture, but the Koblitz conjecture (refined by Zywina in 2011) remains open. The conjectures are now known unconditionally “on average” due to work of Banks–Shparlinski and Balog–Cojocaru–David. Recently, there has been a growing interest in the cyclicity conjecture for primes in arithmetic progressions (AP), with relevant work by Akbal–Güloğlu and Wong. In this article, we adapt Zywina’s method to formulate the Koblitz conjecture for AP and refine a theorem of Jones to establish results on the moments of the constants in both the cyclicity and Koblitz conjectures for AP. In doing so, we uncover a somewhat counterintuitive phenomenon: On average, these two constants are oppositely biased over congruence classes. Finally, in an accompanying repository, we give Magma code for computing the constants discussed in this article.
Support for a high-ambition plastics treaty is gaining strength, particularly within global civil society and among lower-income developing countries. Still, opposition to binding measures – such as obligations to regulate petrochemicals or reduce global plastics production – remains intense and widespread. We propose the concept of a “petrochemical historical bloc” to help reveal the depth and extent of the forces opposing strong global governance of plastics. At the bloc’s core are petrostates and industry, especially producers of oil and gas feedstock, petrochemicals and plastics. Extending its influence are broader social forces – including certain political and economic institutions, consultancy firms and nongovernmental organizations – that reinforce and legitimize the discourses and tactics thwarting a high-ambition treaty. This bloc is driving up plastics production, externalizing the costs of pollution, distorting scientific knowledge and lobbying to derail negotiations. Yet the petrochemical historical bloc is neither monolithic nor all-powerful. Investigating differing interests and evolving politics within this bloc, we contend, can expose disingenuous rhetoric, weaken low-ambition alliances and reveal opportunities to overcome resistance to ambitious governance. In light of this, and toward highlighting fractures and potential counter-alliances and strategies, we call for a global research inquiry to map the full scope and nature of the petrochemical historical bloc.
The primary focus of this article is to capture heterogeneous treatment effects measured by the conditional average treatment effect. A model averaging estimation scheme is proposed with multiple candidate linear regression models under heteroskedastic errors, and the properties of this scheme are explored analytically. First, it is shown that our proposal is asymptotically optimal in the sense of achieving the lowest possible squared error. Second, the convergence of the weights determined by our proposal is provided when at least one of the candidate models is correctly specified. Simulation results in comparison with several related existing methods favor our proposed method. The method is applied to a dataset from a labor skills training program.
I argue that the epistemic aim of scientific theorizing (EAST) is producing theories with the highest possible number and degree of theoretical virtues (call this “TV-EAST”). I trace TV-EAST’s logical empiricist origins and discuss its close connections to Kuhn’s and Laudan’s problem-solving accounts of the aim of science. Despite TV-EAST’s antirealist roots, I argue that if one adopts the realist view that EAST is finding true theories, one should also endorse TV-EAST. I then defend TV-EAST by showing that it addresses the challenges raised against using “the aim of science” metaphor and offers significant advantages over the realist account.