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Transcranial direct current stimulation (tDCS) shows promise for treating depression, but heterogeneous findings from randomised controlled trials (RCTs) – likely due to patient characteristics and methodological differences – limit clear conclusions about its efficacy.
Aims
This individual patient data meta-analysis (IPD-MA) aims to evaluate the efficacy of tDCS for depression and explore moderators of clinical depression improvement.
Method
Databases (PubMed, Embase, Web of Science, Cochrane Library) were searched up to 1 February 2025 for RCTs comparing active versus sham tDCS in acute depressive episodes. The outcomes were Hedges’ g for continuous measures of depressive symptoms, odds ratio for response and remission rates and analyses of individual/methodological moderators of clinical improvement. Acceptability was assessed via dropout rates. Heterogeneity was quantified using the I² statistic. Publication and risk of bias were evaluated with Egger’s test and Cochrane Risk of Bias Tool, respectively.
Results
Of 29 eligible RCTs, 18 data-sets provided IPD, totalling 1246 included in the IPD-MA (651 active, 595 sham; mean age 43.2, 63.4% female). Most studies (90%) had low risk of bias. Active tDCS showed small but statistically significant effects on depression improvement (Hedges’ d = 0.24, 95% CI = 0.11–0.35) and response rates (odds ratio 1.33, 95% CI = 1.04–1.72), with low-to-moderate heterogeneity. No significant difference in remission rates (odds ratio 1.30, 95% CI = 0.98–1.74) and dropout rates (12.7% active, 11.3% sham) were observed between groups. Only sample size significantly moderated clinical improvement, with larger trials showing smaller between-group differences.
Conclusions
In this IPD data-set, tDCS showed modest efficacy for depression. Future research should clarify its mechanisms, considering non-specific placebo effects.
Dysphoria – characterised by irritable tension, pervasive discontent and aversive emotionality – is a clinically significant yet nosologically ambiguous phenomenon. It remains marginalised in major diagnostic systems (DSM-5-TR, ICD-11), relegated to a symptomatic descriptor rather than a validated entity, perpetuating diagnostic imprecision and therapeutic risks.
Aims
This review argues for the formal recognition of dysphoria as a distinct transdiagnostic affective dimension. It synthesises evidence to demonstrate its neurobehavioural correlates, protean manifestations across disorders and the clinical imperative for its operationalisation within dimensional frameworks.
Method
We conducted a synthesis of evidence across neuropsychiatry, phenomenology and diagnostic research. Historical typologies (e.g. directionality (extrapunitive versus intrapunitive), temporality (paroxysmal versus chronic) and structural complexity) and contemporary dimensional models (e.g. RDoC’s Negative Valence Systems) were critically examined.
Results
Dysphoria manifests heterogeneously across conditions: as paroxysmal hostility in epilepsy (e.g. interictal dysphoric disorder), affective estrangement in schizophrenia (irritability blended with detachment) and core dysregulation in personality pathology (e.g. borderline emptiness, antisocial hostility). Its exclusion as a primary construct leads to diagnostic inaccuracy (misattribution to depression or behavioural disorders) and iatrogenic harm (e.g. antidepressant-induced agitation). Historical typologies retain clinical utility for risk assessment and treatment planning.
Conclusions
Operationalising dysphoria within dimensional frameworks is essential to elucidate its unique pathophysiology, mitigate iatrogenic harm and advance targeted interventions. Formal recognition of dysphoria as a distinct construct is an ethical and clinical imperative – failure to do so perpetuates diagnostic imprecision, therapeutic missteps and preventable suffering.
In this paper, I explore the millennium-long presence of the chickpea in premodern China by highlighting three key historical moments. The legume had its first rise to prominence as a cosmopolitan “Muslim Bean” in the Mongol Yuan (1271–1368) imperial diet. It then experienced a phase of obscurity, as the most renowned Chinese herbalist, Li Shizhen 李時珍 (1518–1593), conflated it with the pea. A disparate identity of the legume emerged around the same time, as the bean garnered attention from famine relief specialists, consequently transforming into a source of sustenance. The multiple lives of the chickpea were characterized with a common emphasis on its foreignness, drawing connections to various Eurasian cultures beyond China. The plant’s enduring presence, coupled with ongoing allusions to its alienness, makes it a perpetual foreigner in the broad expanse of the Chinese empire.
Myasthenia gravis (MG) is an autoimmune neuromuscular disorder characterized by fatigable weakness and increased perioperative vulnerability. Postoperative myasthenic crisis, defined as respiratory failure requiring prolonged ventilation or re-intubation, remains a feared complication after surgical procedures such as thymectomy. The efficacy of preoperative interventions such as intravenous immunoglobulin (IVIg) and plasmapheresis remains uncertain. This review examines the evidence supporting risk stratification tools and immunomodulatory strategies to prevent postoperative myasthenic crisis. A comprehensive literature review was conducted focusing on studies evaluating the incidence, risk factors and preventive strategies for postoperative myasthenic crisis in MG patients. Particular emphasis was placed on clinical predictive models and randomized trials assessing preoperative IVIg and plasmapheresis. Recent data suggest the incidence of postoperative myasthenic crisis has declined to below 10%, largely due to advances in surgical technique and perioperative care. Established risk factors include bulbar involvement, reduced pulmonary function and prior crises. Risk prediction models such as the Leuzzi and Kanai scores offer clinically useful stratification. While older retrospective studies favored preoperative plasmapheresis, meta-analyses and randomized trials have yielded mixed results. Randomized trials of IVIg have shown no significant benefit in well-controlled patients, and both interventions carry notable risks and costs. Current evidence does not support the routine use of IVIg or plasmapheresis prior to surgery in all MG patients. A targeted, risk-based approach guided by validated predictive models is recommended to minimize unnecessary interventions and health care system costs.
Proper management of mutual interference plays an important role in the successful simultaneous operation of automotive frequency-modulated continuous-wave (FMCW) radar sensors at different vehicles. Compared to traditional interference handling concepts such as detect-and-mitigate or detect-and-avoid, the detect-and-exploit paradigm turns the originally interfering signals into signals of interest and uses them to obtain information about the environment. Following this idea, a method that implements such an interference exploitation strategy in terms of joint passive spectral sensing and localization of surrounding objects is elaborated and presented in this work. In summary, the method consists of a dedicated radar operational mode and a corresponding signal processing chain including pre-processing, beam steering-based signal component separation, maximum likelihood (ML)–inspired signal parameter estimation, and joint direction of arrival (DoA)-time difference of arrival (TDoA) based object localization. The unique advantage of the presented concept compared to over-the-air synchronization (OTAS)-based solutions is that it can also deal with interferers that change their ramp parameters over time. The applicability of the concept is both theoretically analyzed as well as practically demonstrated by means of measurements in an anechoic chamber, where the position of the interferer and an additional object in the surrounding can be determined with an accuracy of a few centimeters.
William Blake’s theology is expressed in a strange, idiosyncratic idiom that is difficult to pin down. Sometimes Blake is even read as an anti-Christian, proto-Nietzschean thinker. However, in 1910, Chesterton noted Blake’s unusual ‘tenderness’ toward the Catholic faith and even suggested that he was already on the path toward Catholicism. In this paper, I present an interpretation of Blake’s theology, focusing on his early work The Marriage of Heaven and Hell and on the ‘fetters’ that he attributes to Milton, implying that he is free of them. I argue that Blake is a sincere Christian – and, as Chesterton suggested, far closer to Catholicism than one might expect. Blake’s profound and insightful reflection on the epistemological and psychological effects of original sin forge a middle way, akin to that of Catholicism, between a ‘Pelagian’ belief in the ability of human beings to redeem themselves through their own efforts and a Calvinist insistence on humanity’s total postlapsarian depravity.
The compression waves/boundary layer interaction (CWsBLI) in high-speed inlets poses significant challenges for predicting flow separation, rendering traditional shock wave/boundary layer interaction (SWBLI) scaling laws inadequate due to unaccounted effects of the coverage range of compression waves. This study aims to establish a unified scaling framework for CWsBLIs and SWBLIs by proposing an equivalent interaction intensity. Experiments were conducted in a Mach 2.5 supersonic wind tunnel, employing schlieren imaging and pressure measurements to characterise flows induced by curved surfaces at two deflection angles ($10^{\circ }, 12^{\circ }$) and varying coverage ranges of compression waves ($d$). An equivalent transformation method was developed to convert the CWsBLI into an equivalent incident SWBLI (ISWBLI), with interaction intensity derived from pressure gradients considering the coverage range. Key results reveal a critical threshold based on the interaction length of ISWBLI ($L_{\textit{single}}$): when $d \leq L_{\textit{single}}$, the interaction scale remains comparable to ISWBLI; when $d \gt L_{\textit{single}}$, the weakened adverse pressure gradient leads to a reduction in the length scale. The proposed scaling framework unifies the CWsBLIs and SWBLIs, achieving better data collapse compared to the existing methods. This work advances our understanding of complex waves/boundary layer interactions, and provides a prediction method for the length scales of CWsBLIs.
This paper proposes and experimentally validates four origami-inspired reconfigurable waveguide antenna designs, including the vertical folded waveguide antenna, the tilted waveguide antenna, the bellowed tilted waveguide antenna, and the fan-fold horn antenna. Aimed at overcoming the inherent limitations of rigid waveguide, those designs use mechanical deformation to control electromagnetic performance. By leveraging simple folding mechanisms, those proposed structures can turn antenna’s key parameters such as operating frequency, beam direction, beamwidth, gain and beam shape without relying on active components or complex beamforming circuitry. All prototypes were handcrafted as proof-of-concepts and successfully demonstrated their targeted functionality, showing the great potential in applications that require occasional reconfiguration rather than rapid, continuous adjustment. These results also reveal how origami techniques can unlock new design freedom for compact, reconfigurable antennas for future communication and sensing system.
No matter the methodology, gaining access to potential research participants is one of the more difficult aspects of conducting field research. Sometimes, potential participants may be “hard to reach”—for example, they are physically located in remote areas where the lack of infrastructure necessitates extensive travel and/or difficult logistics. Alternatively, they may be “vulnerable” due to disenfranchisement (incarcerated populations), stigma (those living with HIV/AIDS), or at risk if they share their experiences (people living in authoritarian states). Or participants may be “hidden”—that is, no record of their experiences exists, which, in turn, makes it difficult to find and recruit them (Ellard-Gray et al. 2015).1
A review was carried out of studies on the diet of various Mediterranean teuthivorous predators (marine mammals, chondrichthyans, osteichthyans, seabirds, turtles, crustaceans, and cephalopods) and their cephalopod prey. Data extracted from the literature were analysed using multivariate statistical techniques. Three distinct groups of predators were identified according to the cephalopod species consumed. The most common prey of the predators are the ‘unidentified Cephalopoda’, followed by the sepiolid Heteroteuthis dispar and the ommastrephid squid Illex coindetii. The most important cephalopod predators are the striped dolphin, Stenella coeruleoalba, the chondrichthyans Scyliorhinus canicula and Galeus melastomus, the swordfish Xiphias gladius, and the ommastrephid squid Todarodes sagittatus. The dietary preferences of the different teutophages, their geographical distribution and some ecological implications are discussed.
This paper provides a profound perspective on the neuronal property of radiofrequency (RF) power amplifiers (PAs). The nonlinearity of the PA is studied for the first time by solving differential equations in a bio-inspired neuromorphic model, i.e. Hodgkin–Huxley model, with Bayesian estimation. This study demonstrates that the nonlinearity of RF components is biomimicking and thus can enhance neuromorphic computing capacities of a communication network under the framework of a joint communication and computation (J2C) scheme. Overall, our work contributes to incorporating artificial intelligence (AI) and automation into the communication network, a key trend in 6G.
This article explores how psychiatrists conceptualised the role of family relations and emotional atmospheres in the context of schizophrenia research in the second half of the twentieth century. It traces how families became the primary site to be mined and measured to explain schizophrenia’s onset, course and outcome, and zooms in on global psychiatric investigations of expressed emotion in families of schizophrenic patients, which aimed to offer a theoretical framework for understanding one of the most intriguing and influential findings of transcultural psychiatry: that schizophrenia appeared to have a shorter course and favourable recovery rates outside the Western world. The article engages with a wealth of research materials from schizophrenia and expressed emotion studies, and a variety of voices – clinicians, patients, families – which shaped these investigations. It also draws a comparison between this discussion of ‘traditional’ families as a beneficial environment for schizophrenia, and critical psychiatric and psychoanalytic discourses from the middle decades of the century which focused on the reportedly extreme psychopathological potential of ‘schizophrenogenic’ family relations in the Western world. Analyzed through this prism, expressed emotion research constructed the Global South as a preferable, even romanticized, alternative to the Western model of family interaction. On closer inspection, however, this idealization of the traditional family involved a variety of essentializing and romanticizing ideas which reinforced the ever-present binary of the modern West versus backward Global South, and perpetuated the belief in the decolonising and developing world’s cultural and intellectual simplicity.
Using linear stability analysis, we study the onset and formation mechanism of wall modes in confined magnetoconvection cells with the degree of confinement characterised by the cell aspect ratio $\varGamma$. We first outline the phase diagram of the dominating factors that determine the critical Rayleigh number $Ra_c$ for the onset of convection in the $\varGamma -Ha$ phase space, with $\textit{Ha}$ being the Hartmann number. Our study shows that $Ra_c$ is primarily determined by geometrical confinement, and bulk convection onset occurs with $Ra_c = 1090 \varGamma ^{-4.0}$ for $\varGamma \lt \varGamma _{c_1} = 1.21 \textit{Ha}^{-0.48}$. No wall modes form and $Ra_c$ depends on the strength of both the confinement and magnetic field for $\varGamma _{c_1} \leqslant \varGamma \lt \varGamma _{c_2} = 4.07 \textit{Ha}^{-0.53}$. For $\varGamma _{c_2}\leqslant \varGamma \lt \varGamma _{c_3}=0.99 \textit{Ha}^{-0.10}$, wall modes emerge and $Ra_c$ drops below the bulk onset Rayleigh number for magnetoconvection. When $\varGamma \geqslant \varGamma _{c_3}$, wall modes become fully developed with an onset Rayleigh number for wall modes $Ra_{c,w} \approx 65 \textit{Ha}^{1.5}$. In this fully developed regime, the radial velocity profile and $Ra_{c,w}$ become independent of $\varGamma$. Through analysing the length scales of wall modes and their interaction with spatial confinement, we show dynamically how wall modes emerge in confined cells: while the first layer with a characteristic length scale $\ell _1 = 1.04 \textit{Ha}^{-0.56}$ forms when $\varGamma \geqslant 5.39 \textit{Ha}^{-0.58}$, the second layer with a characteristic length scale $\ell _2 = 4.94 \textit{Ha}^{-0.56}$ emerges when $\varGamma \geqslant 9.07 \textit{Ha}^{-0.53}$. These scaling relations provide practical guidelines for experimental and numerical studies of the wall-mode dynamics.
To assess differences in SARS-CoV-2 infection rates between patients receiving hemodialysis in outpatient centers (in-center) and those receiving dialysis in their homes (hemodialysis and peritoneal dialysis) from December 29, 2020, through May 9, 2023.
Design:
Retrospective cohort study.
Setting:
Outpatient dialysis facilities in the United States reporting to the Centers for Disease Control and Prevention’s National Healthcare Safety Network.
Patients:
Maintenance dialysis patients that received hemodialysis treatment at or were affiliated with outpatient dialysis facilities.
Methods:
SARS-CoV-2 infection rates were assessed by dialysis setting (in-center and home). Weeks were categorized as surge (rate of infection > median) and non-surge (rate of infection ≤ median) and by variant predominance. A negative binomial regression model with generalized estimating equations was constructed to examine differences in rates of infection among patients.
Results:
A total of 7,974 dialysis facilities reported 171,338 SARS-CoV-2 infections among patients. In-center hemodialysis patients had higher average rates of SARS-CoV-2 infection at 2.85 infections per 1000 patient-weeks than home patients at 1.69 infections per 1000 patient-weeks. During surge weeks, the differences in rates of infection between in-center and home patients were more pronounced than during non-surge weeks for all variant predominance categories: Delta (relative rate ratio (RRR) = 1.20, CI: 1.09–1.32), B.1 and Other (RRR = 1.11, CI: 1.02–1.22), and Omicron (RRR = 1.07, CI: 1.01–1.12).
Conclusion:
Rates of SARS-CoV-2 infection among patients receiving outpatient hemodialysis were persistently higher than rates among patients receiving dialysis treatments at home; these differences were more pronounced during surge weeks.
This study proposes a radial basis function neural network disturbance observer- (RBFNNDO) based anti-saturation backstepping controller for hypersonic vehicles with input saturations and multiple disturbances. Firstly, in response to the problem of ‘exploding complexity’ in backstepping controller, we adopt finite-time tracking differentiators (FTD), which realise higher tracking accuracy and tracking speed than those of the existing methods. Secondly, we develop multivariable neural network disturbance observers to estimate the lumped disturbances involving aerodynamic uncertainties and external disturbances, thereby improving the robustness of the proposed controller. Thirdly, in order to alleviate the input saturation and minimise the duration time, we use an adaptive fixed-time anti-saturation compensator (AFAC). The simulation results have proven that our proposed backstepping controller outperforms other existing methods in terms of control performance and saturation time.