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Neuroinflammatory syndromes in children often present with overlapping clinical, radiological and immunological features, posing significant diagnostic challenges. We describe two pediatric patients with acute neuroinflammatory presentations who fulfilled criteria for a well-recognized antibody-associated demyelinating disorder but also demonstrated clinical and laboratory features suggestive of a broader hyperinflammatory process. These cases underscore the diagnostic complexity when systemic and central nervous system inflammation coexist and highlight the importance of maintaining a broad differential diagnosis. Clinicians should be aware that antibody positivity does not preclude alternative or coexisting diagnoses and that failure to recognize hyperinflammatory syndromes may delay appropriate therapy.
Depressive and anxiety disorders often co-occur with insomnia, creating complex treatment challenges. Although clinical guidelines recommend psychotherapy as first-line treatment for these comorbid conditions, limited access to psychological services in primary healthcare facilities in China often leads to heavy reliance on pharmacological therapy.
Aims
To the appropriateness of psychotropic medications for patients with insomnia comorbid with depressive or anxiety disorders at primary healthcare facilities in China.
Method
This cross-sectional study included patients with documented diagnoses of insomnia comorbid depressive or anxiety disorders in 2022 at all 67 primary healthcare facilities in Dongcheng District, Beijing, China. The primary outcome was the prescribing rate of guideline-recommended psychotropic medications.
Results
Among 842 patients with insomnia and depressive disorders and 1014 patients with insomnia and anxiety disorders, over 90% received psychotropic medications. Benzodiazepines were the most frequently prescribed classes (55.9 and 69.6%), followed by non-benzodiazepine hypnotics (42.5 and 42.4%), whereas medications recommended by the guideline, including antidepressants with sedative effects, selective serotonin reuptake inhibitors and selective norepinephrine reuptake inhibitors, were used infrequently. Only 29.9% of patients with insomnia and depressive disorders and 11.5% of those with insomnia and anxiety disorders received guideline-recommended pharmacotherapy, with lower concordance among older adults.
Conclusions
Guideline-recommended pharmacotherapy for insomnia comorbid with depressive or anxiety disorders was rarely implemented at primary care in China. This highlights the need to facilitate evidence-based practices and improve management of comorbid mental health conditions, particularly for older adults.
Portunid crabs of the genus Charybdis De Haan, 1833 are among the most frequently reported marine invaders worldwide. Here, we report the first record of Charybdis (Archias) hoplites (Wood-Mason, 1877) outside its native Indo-West Pacific range, collected from the Test Estuary, Southampton Water, United Kingdom. Morphological and molecular analyses confirm the specimen’s identity and clarify diagnostic features useful for distinguishing C. (A.) hoplites from closely related taxa. This represents the northernmost record of any Charybdis species and suggests a long-distance dispersal event, associated with shipping activities in the Port of Southampton. Environmental data indicate that salinity and turbidity at the collection site are within known tolerances for Charybdis spp., although low winter temperatures may limit survival and establishment. The detection of this warm-water species in a major international port highlights the ongoing need to monitor non-native marine fauna.
While European integration has transformed national parliaments, its long-term impact on conflicts between governments and opposition parties remains insufficiently understood. This study addresses that gap by analysing how Sweden’s accession to the European Union (EU) in 1995 altered the patterns of parliamentary opposition. Using longitudinal data on government proposals in the Swedish parliament, 1970–2022, we apply a difference-in-differences design to compare opposition intensity before and after accession. Our findings reveal two major transformations. First, we identify a sustained decline in opposition in internationally embedded economic and tax policies, supporting the view that the EU political system structurally depoliticises economic governance. Second, we observe a gradual but pronounced politicisation in policy areas tied to national identity and social welfare, where EU competences are limited and domestic discretion remains. We thus find that European integration reshapes parliamentary conflict by dampening opposition in economic policymaking while intensifying contestation in policy areas related to national identity and social protection. Rather than reducing opposition overall, EU membership redirects it across issue areas. Taken together, the results show that the distribution of national and supranational competences conditions parliamentary opposition. As Sweden is a most likely case of EU-induced cleavage transformation, similar dynamics are likely across other member states as well. The study advances parliamentary research by shifting attention from formal powers and debates to observable opposition behaviour over time. It also adds to theories of modern-day cleavage formation by providing evidence that European integration reduces conflict in economic policy while intensifying identity-based divides.
Lycium barbarum by-products (LBPs), including residual branches, leaves and fruits generated during processing, are rich in bioactive compounds exhibiting antioxidant, anti-inflammatory and immunomodulatory properties. However, their efficient utilization remains limited. This study investigated the effects of fermentation duration on the chemical composition and bioactivity of LBPs. Anaerobic solid-state fermentation was conducted using a mixed microbial consortium of Bacillus subtilis PFK1702, Lactobacillus, and yeast for 0 (CON), 3 (F3) and 5 (F5) days. Fermentation significantly altered the nutritional composition of LBPs, increasing crude protein and total polyphenol contents while reducing crude fat and crude fiber levels (P < 0.05). Nontargeted metabolomics identified 16 flavonoid metabolites, including 6,7,8-tetrahydroxy-5-methoxyflavone, diosmetin, rhamnocitrin, hispidulin, nepetin, luteolin-7-O-glucoside (cynaroside) and others. Most flavonoid metabolites were upregulated in F3 and F5 compared with CON, with the highest accumulation observed after 5 days of fermentation. KEGG pathway enrichment analysis indicated that luteolin-7-O-glucoside (cynaroside) may participate in the flavonoid biosynthetic pathway of LBPs, although further experimental validation is needed. Overall, prolonged fermentation enhanced flavonoid biosynthesis and improved the nutritional and functional properties of LBPs, suggesting that a 5-day fermentation period is optimal. These results offer theoretical and practical insights into the valorization of LBPs as functional feed or natural antioxidant resources.
Screening tools for attention-deficit/hyperactivity disorder (ADHD) help to identify individuals likely to have ADHD. Several screening scales are used for identifying adults with ADHD, based on criteria outlined in the Diagnostic and Statistical Manual of Mental Disorders (DSM). The ADHD symptoms described in the DSM were originally developed to describe the behaviours of children, not adults, and focus on the triad of symptoms of inattention, hyperactivity, and impulsivity. Clinical research and experience, however, have revealed additional dimensions of adult ADHD, such as hyperfocus, racing thoughts, emotional lability, impaired sleep, and differences in time perception. Commensurate with the conditions’ growing recognition, the adult ADHD presentation requires rethinking.
Methods:
To understand better the ADHD symptomatology experienced by adults, qualitative interviews were conducted with 11 diagnosed adults.
Results:
Using thematic analysis, nine themes of adult ADHD symptoms were identified. The first three themes map to the original triad of symptoms – attentional difficulties, hyperactivity, and impulsivity. A further three themes identified are briefly mentioned in the DSM – disorganisation, forgetfulness, and reduced activation. The final three themes are covered to some degree in the current rating scales but are absent from the DSM 5 – emotional lability, sleep difficulties, and time perception difficulties.
Conclusions:
This study highlights nine themes relevant to adult ADHD, six of which are absent from the DSM 5’s triad. This research highlights gaps in current assessment tools and suggests symptoms that are more reflective of the adult experience of having ADHD.
This paper explores dispersive shock waves (DSWs) of gravity-capillary waves within the framework of the two-dimensional, fully nonlinear Euler equations. In this system, initial wave profiles characterised by a smooth step function evolve into modulated wavetrains that connect different constant states, a phenomenon arising from the interplay between nonlinear and dispersive effects. The Bond number, which quantifies the relative significance of gravity compared to surface tension, is crucial in determining the behaviour of the DSW solution. As the Bond number increases from zero, solutions traverse four distinct zones: the radiating DSW region, an unstable crossover region, the travelling DSW region, and the inverse radiating DSW region. The propagation velocities of DSWs can be estimated using the DSW fitting method alongside numerical results from travelling waves. Particular attention is given to travelling DSWs, which are characterised by a uniform wavetrain followed by an oscillatory decaying wavepacket. Notably, the high platform and its extended periodic wavetrain can be part of a specific type of gravity-capillary solitary wave that features an oscillatory pulse, with the number of oscillations at the core potentially increasing indefinitely. The Whitham modulation theory for the Euler equations is employed to describe the modulation parameters – such as wavenumber, amplitude and wave mean – in the travelling DSW region. Finally, we discuss the bifurcation mechanism of solitary waves with oscillatory pulses in the Euler equations, along with analyses of their stability. It is also demonstrated that for relatively small Bond numbers, a series of trapped bubbles can occur along the bifurcation curves, representing the limiting configuration of this type of solitary wave.
Coal balls are our primary source of information about Pennsylvanian tropical peat swamps. They capture plant community composition and the complex ecological interactions between coeval terrestrial arthropods and plants. A small number of borings (or feeding tunnels) have been documented in permineralized and compression fossils from the Carboniferous Period. We report two borings filled with coprolites (fecal material) in a coal ball originating from the Mt. Rorah Coal Member (Tradewater Formation; Middle Pennsylvanian of Illinois, USA). Peels of the coal ball were prepared using the cellulose acetate peel method and digitized with a Zeiss Axio Zoom V16 microscope. The borings, measuring 3 cm and 6 cm in length, follow the transverse margin of Psaronius roots and are filled with two distinct types of uniformly shaped coprolites: type 1, ranging from 0.5–2 mm in diameter, and type 2, <60 μm in diameter. Both coprolite types consist of digested Psaronius root tissue and only occur in borings, with no signs of feeding damage observed in the surrounding plant tissues along the margins of the borings or the peel. The dimensions of the borings and morphology of type 1 coprolites suggest they were made by an early roachoid, millipede, or another terrestrial arthropod group. The distribution and content of type 2 coprolites indicate coprophagy, or secondary feeding on type 1 coprolites, likely by oribatid mites. These borings provide new insight into the life history of the organisms that created these tunnels, their role in litter decomposition, and the food webs of Pennsylvanian peat swamps.
Hepatocellular carcinoma (HCC) is associated with high mortality and imposes substantial symptom and psychological burdens; however, the impact of different treatment modalities on quality of life (QoL) and mental health remains underexplored. This study aimed to examine the associations among symptom distress, depression, and QoL across various HCC treatments.
Methods
A cross-sectional study was conducted with 101 inpatients at a regional hospital in Taiwan (October 2020–December 2021). Patients received hepatic resection (HR), radiofrequency ablation (RFA), transarterial chemoembolization (TACE), hepatic arterial infusion chemotherapy (HAIC), or immunotherapy (IT). Data were collected using the European Organization for Research and Treatment of Cancer Quality of Life Questionnaire Core-30 (EORTC QLQ-C30), the Hospital Anxiety and Depression Scale (HADS), and the Brief Symptom Rating Scale (BSRS).
Results
RFA patients reported better functional scores (96.13 ± 7.55) and lower HADS scores (18.31 ± 4.92) than those treated with TACE, HAIC, or IT (function: 87.77 ± 17.77; HADS: 23.26 ± 7.66). These differences may reflect earlier disease stage and better baseline health in RFA recipients. Older age and advanced stage were associated with poorer global health (p < 0.05), while female gender (β = − 7.38, p = 0.014) and disease recurrence (β = − 6.48, p = 0.019) were associated with lower functional status.
Significance of results
Treatment type, disease stage, and demographics significantly shape QoL and mental health in HCC patients. Minimally invasive therapies like RFA may preserve QoL in early-stage disease, while invasive or palliative treatments necessitate greater psychosocial support.
An agent’s epistemic prospects depend on a combination of that agent’s individual characteristics and features of that agent’s epistemic environment. Such factors cannot always be cleanly separated. Often, individual characteristics impact agents’ epistemic prospects by shaping the epistemic environments in which individuals find themselves. In particular, features of individuals often repel or attract certain sorts of information, a phenomenon I label epistemic magnetism. I argue that epistemic magnetism is a ubiquitous and underrecognized phenomenon that sometimes promotes and sometimes frustrates the achievement of positive epistemic outcomes. Then, I consider a series of simple proposals concerning what distinguishes between beneficial and harmful forms of epistemic magnetism. I argue that these proposals cannot capture the impacts of epistemic magnetism. Instead, I offer a series of principles that serve to roughly characterize the consequences of this phenomenon. I conclude with some remarks on why epistemologists have thus far tended to overlook epistemic magnetism.
Political science educators must take innovative approaches to respond to twenty-first-century classroom challenges. Simulation-based pedagogy can foster deep student engagement while developing strong peer relationships, encouraging empathy, and improving professional skills. There are many ways, however, to conduct simulations in political science courses. We argue that open-ended, multi-week simulations in which students participate as relative equals may be especially beneficial for effective learning. Although this “sandbox”-style approach to simulation learning is portable to other settings, we have used it in legislative politics courses focused on the US Senate. Drawing from our experiences and student reviews, we argue that simulations in which students can immerse themselves in a role for an extended period, focus on issues they care about, and learn from their mistakes and successes along the way create a uniquely valuable learning experience. Our approach can present challenges for instructors, but we believe it is flexible enough to be deployed in a variety of institutional settings and that any trade-offs are more than worth it.
We introduce semiframes (an algebraic structure) and investigate their duality with semitopologies (a topological one). Both semitopologies and semiframes are relatively recent developments, arising from a novel application of topological ideas to study decentralised computing systems. Semitopologies generalise topology by removing the condition that intersections of open sets are necessarily open. The motivation comes from identifying the notion of an actionable coalition in a distributed system – a set of participants with sufficient resources for its members to collaborate to take some action – with an open set, since just because two sets are actionable (have the resources to act) does not necessarily mean that their intersection is. We define notions of category and morphism and prove a categorical duality between (sober) semiframes and (spatial) semitopologies, and we investigate how key well-behavedness properties that are relevant to understanding decentralised systems transfer (or do not transfer) across the duality.
For $r\geq 3$ and $g= \frac {r(r+1)}{2}$, we study the Prym-Brill-Noether variety $V^r(C,\eta )$ associated to Prym curves $[C,\eta ]$. The locus $\mathcal {R}_g^r$ in $\mathcal {R}_g$ parametrizing Prym curves $(C, \eta )$ with nonempty $V^r(C,\eta )$ is a divisor. We compute some key coefficients of the class $[\overline {\mathcal {R}}_g^r]$ in $\mathrm {Pic}_{\mathbb {Q}}(\overline {\mathcal {R}}_g)$. Furthermore, we examine a strongly Brill-Noether divisor in $\overline {\mathcal {M}}_{g-1,2}$: we show its irreducibility and compute some of its coefficients in $\mathrm {Pic}_{\mathbb {Q}}(\overline {\mathcal {M}}_{g-1,2})$. As a consequence of our results, the moduli space $\mathcal {R}_{14,2}$ is of general type.
This paper explores the paradox of secularism in Chile’s 2022 constitutional proposal, celebrated as the “world’s most progressive” yet decisively rejected in a national referendum. The drafters sought to secularize Chile’s political institutions by curbing the influence of mainstream religions—above all, Catholicism—while simultaneously granting broad recognition and autonomy to Indigenous worldviews, including their spiritual and ritual dimensions. This dual strategy raises the question of whether the constitution merely substituted one religious framework for another under the guise of decolonial justice. To explain this apparent contradiction, the paper distinguishes between two axes of division: a first-order cleavage of oppressors vs. oppressed, which shaped the draft’s core commitments, and a secondary secular vs. religious cleavage, which played a subordinate role. The analysis concludes that Indigenous worldviews were embraced not as religious doctrines but as expressions of historically wronged communities deserving redress, whereas institutional religion was sidelined as a marker of colonial oppression. The paper contributes to debates on constitution-making and secularism in non-European contexts, illustrating how secular projects can entangle with alternative substantive doctrines in pursuit of historical justice.