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Dyslipidemia is associated with chronic low-grade inflammation and immune dysfunction, but the immunological effects of dietary phytosterols in humans remain unclear. We conducted a secondary analysis of an outcome-assessor-blinded, randomized controlled feeding trial to evaluate the effects of a high-phytosterol (HPS) diet, using phytosterol-enriched corn–wheat germ blended oil, compared with a low-phytosterol (LPS) diet using peanut oil, on systemic inflammatory markers, humoral immune markers and peripheral blood lymphocyte subsets in Chinese adults with dyslipidemia. After a 2-week run-in period, 104 participants were randomized to the HPS group (n=52) or the LPS group (n=52) for 12 weeks. In intention-to-treat analyses, the HPS group had a higher CD4+/CD8+ ratio at 12 weeks than the LPS group (adjusted mean difference: 0.561; 95 % CI: 0.060, 1.063; P = 0.03) and a lower CD8+ T-cell count (adjusted mean difference: -116.315 cells/μL; 95 % CI: -215.781,-16.849; P = 0.02). No significant between-group differences were observed for systemic inflammatory markers, humoral immune markers or most other lymphocyte subset outcomes. In per-protocol analyses, the difference in CD4+/CD8+ ratio remained significant, whereas the reduction in CD8+ T-cell count was attenuated. These exploratory findings suggest that a 12-week phytosterol-enriched corn–wheat germ blended oil intervention may be associated with changes in T-cell subset balance in adults with dyslipidemia, although the results should be interpreted cautiously given the exploratory nature of this secondary analysis.
Older adults in long-term care (LTC) homes experience complex nutrition-related challenges and care staff are central to supporting nutrition care, eating assistance, and positive mealtime experiences. However, nutrition care education is often inconsistently addressed in staff training. This scoping review mapped the scope, characteristics, and reported the outcome measures of nutrition care education and programs for LTC staff. This review followed JBI methodology and was reported according to PRISMA-ScR guidelines. Four databases (MEDLINE, CINAHL, Scopus, and PsycINFO) were searched from May to October 2024, with an updated search in September 2025. Grey literature and reference lists were also searched. Sixteen studies met the eligibility criteria. Programs varied in content, delivery format, duration, target staff groups, implementation supports, and outcomes. Common outcomes included staff knowledge, confidence, attitudes, eating assistance practices, mealtime environment, feasibility indicators, and selected resident nutrition outcomes. Future research should improve reporting, follow-up, outcome definitions, implementation, feasibility, and continuity.
In practical combustion systems, co-firing of ammonia (${\rm NH}_3$) with blends of methane (${\rm CH}_4$) and hydrogen (${\rm H}_2$) offers a promising pathway towards low-carbon combustion. However, the nonlinear thermoacoustic oscillations arising from such multi-fuel blends remain poorly understood, particularly in systems supporting intrinsic thermoacoustic (ITA) modes. In this study, we experimentally investigate the effects of varying fuel composition on thermoacoustic instability in a partially premixed swirl-stabilised combustor. Operating at a fixed thermal power ($k=4100\,\mathrm{W}$) and equivalence ratio ($\phi =0.85$), we systematically vary the fuel composition across blends of ${\rm CH}_4$, ${\rm H}_2$ and ${\rm NH}_3$, mapping the resulting dynamical transitions. We show that the system exhibits a sequence of nonlinear states depending on hydrogen enrichment: periodic limit-cycle for pure methane, quasiperiodicity at moderate ${\rm H}_2$ ($P_{\textrm{H}_2} = 0.2$–0.3) and period-3 state at higher enrichment ($P_{\textrm{H}_2} = 0.4$–0.5), all at fixed $P_{\textrm{NH}_3}$. As hydrogen content increases, the system undergoes mode-switching transitions within the ITA mode family, from high-frequency fourth-harmonic ($f_1$) to first-harmonic ($f_2$) oscillations, associated with strong pressure amplitudes and modified flame structures. Conversely, increasing ammonia content at constant $P_{\textrm{H}_2} \lt 0.3$ suppresses oscillation amplitudes across both periodic and quasiperiodic regimes. Our chemiluminescence imaging analysis reveals that the ITA-driven instabilities at its first harmonic ($f_2$) with shorter, flatter, M-shaped flames exhibit reduced flame response time and intensified heat release concentrated near the dump plane, leading to thermoacoustic amplification. These findings demonstrate that mode switching through precise tuning of $P_{\textrm{H}_2}$ and $P_{\textrm{NH}_3}$ offers new insights for the design of low-emission, fuel-flexible combustion systems.
We contribute to research addressing links between forest restoration and human well-being with an experimental study testing how exposure to a restored forest and birdsong impact mental stress, positive and negative experiences and perceived restorativeness. This study engaged 106 campus participants at North Carolina State University in a 2 × 2 experiment to assess the impacts of soundscapes (i.e., traffic noise versus birdsong) and a restored riparian forest (compared to proximate grey space). Soundscape and location were drivers of all well-being metrics (p < 0.001 for main effects in every case, with effect sizes ranging from η2 = 0.05 to 0.34). The restored forest with birdsong combination elicited the lowest stress, lowest negative experiences, highest positive experiences and highest perceived restorativeness (p < 0.05). The grey space with traffic noise combination was always the least beneficial (p < 0.05), and mixed treatments yielded intermediate results. These results build evidence that exposure to restored forest reduces stress, increases well-being and assists with perceived restorativeness; they also suggest that birdsong soundscapes have additive beneficial effects. These findings support the value of ecological restoration in urban areas, particularly when landscape restoration is accompanied by restoration of bird communities.
We analyse velocity spectra from direct numerical simulations (DNS) of turbulent pipe flow up to a friction Reynolds number $ \textit{Re}_{\tau } \approx 12{\,}000$. The spectral maps naturally partition into four regions, corresponding to small- and large-scale motions, and to wall-attached eddies, and are further divided into near-wall and outer contributions. Physically grounded models are formulated for each region, with particular emphasis on the near-wall range beneath the wall-attached eddies. Integration of the spectral models yields the distribution of the streamwise velocity variance in the lower part of the logarithmic layer, which agrees well with the DNS data. The analysis shows that the emergence of an outer-layer peak in the velocity variance at sufficiently high Reynolds number arises from the increasing relative contribution of wall-attached eddies, and can be interpreted without invoking additional physical mechanisms beyond this classical framework. Extrapolation to extremely high Reynolds numbers suggests a saturation of the velocity variance, characterised by two peaks of comparable magnitude.
AI provides a rich source of challenging examples for theories of agency because it allows relevant features to be relatively freely combined. This paper considers agency in sequence models: models that have been trained to predict the next item in a sequence. Training models on sequences of observations and actions can yield systems that use reinforcement learning in context, as well as ones that merely imitate agents. Investigating AI systems from this group suggests a requirement that agents must learn about the environment in part from their own interaction with it. It also suggests a distinction between two alternative approaches to understanding agency.
Antidepressants are the most frequently prescribed medications in psychiatry. Medical records of thousands of individuals provide a valuable opportunity to explore prescribing patterns and identify factors that influence treatment outcomes.
Aims
To investigate antidepressant change patterns in depression and non-depression indications and assess clinical and genetic factors associated with outcomes of antidepressant treatment.
Methods
Using primary care records from the UK Biobank, we examined outcomes including number of antidepressant changes and discontinuation due to either side-effects or inadequate response. Genetic analyses including heritability estimation, genetic correlation and polygenic score association were performed.
Results
A total of 82 633 individuals were prescribed at least 1 antidepressant. Of these, 28 332 individuals with at least 1 primary care depression diagnosis were classified as the depression group, and 24 543 individuals without evidence of depression were classified as the non-depression group. Citalopram and fluoxetine were the most prescribed antidepressants for depression, whereas amitriptyline dominated prescriptions for non-depression indications. Individuals with depression were more likely to stay on antidepressants longer than those without depression and to follow preferred antidepressants that changed over time. Antidepressant changes and discontinuation were associated with a range of psychiatric and somatic conditions, including recurrent depression (early discontinuation: odds ratio = 1.96; late discontinuation: odds ratio = 2.63) and anxiety (early discontinuation: odds ratio = 1.37; late discontinuation: odds ratio = 1.99) in the depression group, and pain-related conditions in the non-depression group. Genetic analyses identified two novel variants associated with early discontinuation of selective serotonin reuptake inhibitors. Notable genetic overlap was shown between these outcomes and multiple psychiatric and physical traits, including the number of antidepressant changes with anxiety and depression (rg = 0.81–0.83), and polygenic scores for depression and attention-deficit hyperactivity disorder showed significant predictive value with respect to treatment outcomes.
Conclusions
These findings characterise antidepressant change patterns in primary care records and highlight the potential value of integrating clinical and genetic data to better understand factors associated with treatment outcomes.
This paper examines three early Roman priesthoods, specifically, the Vestal virgins, the Salii, and the Flamines, through the lens of their visual and symbolic prerogatives, adopting a diachronic perspective based on literary sources, iconographic evidence, and archaeological data. The study highlights the deep historical roots of priestly paraphernalia in pre- and proto-historic funerary contexts, as well as a significant shift in gender dynamics. Prior to the 8th c. BCE, numerous male religious and martial figures are depicted with double shields and other distinctive attributes. From the 8th c. BCE to the Archaic period, both male and female religious figures appear, often equipped with knives, while double shields gradually disappear. This pattern suggests an expanding definition of religious and political prerogatives. By the 8th c. BCE, specialized male and female figures (identified by their knives) assume religious roles, whereas male warriors become kings (reges), holding political authority and often serving as Augurs as well.*
Ultra-processed food (UPF) consumption has generated a great deal of concern among nutrition scientists and consumers due to its potential relationship with increased risk of adverse health impacts. Evidence from intervention studies comparing UPF-rich and less-processed diets on cardiometabolic health outcomes is limited. Clinical trials that have been published to date focus on comparing more- and less-processed diets, as defined by the Nova system, and their impact on weight-related outcomes. Only one trial compares equally healthful more- and less-processed diets. The Dietary Guidelines for Americans with Ultra-Processed foods (DGA-UP) study will be the first trial to examine whether there is a differential effect to following recommendations from the 2020-2025 Dietary Guidelines for Americans (2020 DGA) including more- or less-processed foods as defined by the Nova classification system on cardiometabolic disease risk factors. A randomized controlled crossover dietary intervention study, DGA-UP will be conducted with 4 week provision of all meals to generally healthy male and female adults at eucaloric levels. The trial will consist of 2 dietary arms: 1) a less-processed 2020 DGA diet and 2) a ultra-processed 2020 DGA diet. The primary outcome is change in blood pressure on each diet from baseline to week 4. Both interventions will have excellent diet quality and contain similar amounts of macronutrients and micronutrients as well as the same types of food. DGA-UP will help to fill a significant research gap regarding potential impact of UPFs on cardiometabolic health markers independent of food type, diet quality, and micronutrient content. ClinicalTrials.gov registration: NCT07252037
We investigate the heat transport in porous media convection (PMC) over a wide Rayleigh–Darcy number range of $26.8\leqslant Ra\leqslant 2.62\times 10^5$, and a Darcy number range of $6.18\times 10^{-7}\leqslant Da\leqslant 1.21\times 10^{-5}$. In the experiments, we employ 3D-printed lattice structures as the solid porous matrix and water as the working fluid. Quantitative analyses of the porous medium Nusselt number $ \textit{Nu}_m$ and local temperature statistics reveal that the present system undergoes a transition through five distinct regimes: (I) conduction, (II) convection, (III) oscillation, (IV) transition, (V) classical Rayleigh–Bénard convection. This transitional process bridges the gap between Rayleigh–Darcy-like behaviour and Rayleigh–Bénard-like behaviour in PMC. By varying the permeability of the matrix, we further examine the role of the Darcy number $ \textit{Da}$, which turns out to have a profound impact on the transitional processes across different regimes. Flow field measurements reveal that the flow structures within regime IV and regime V evolve from several horizontally stacked convection rolls to a single-roll structure, and the pore-scale Reynolds numbers both exceed unity in these two regimes. Finally, we report the corresponding phase diagram in the $ \textit{Ra}$–$ \textit{Da}$ space.
While the World Health Organization established minimum standards for emergency medical teams (EMTs) in 2013, globally recognized competency standards for individual disaster medical responders remain lacking. This study identifies and synthesizes existing competencies, qualifications, and training requirements for physicians, nurses, and paramedics who serve as deployable disaster response specialists on EMTs.
Methods
A scoping review was conducted following PRISMA-ScR guidelines. Comprehensive searches of five databases were performed in September, 2024. Gray literature from 22 governmental and non-governmental organizations was also reviewed. Studies addressing competencies or requirements for disaster specialists (physicians, nurses, paramedics) participating in disaster response were included.
Results
Fifty-four studies were included, most being nursing-focused (n = 28, 51.9%). Studies predominantly originated from the United States (n = 15, 27.8%) and China (n = 9, 16.7%). Training program duration ranged from single-day workshops to multi-week courses, with varied delivery formats. Core competencies identified across professions included Incident Command System knowledge, triage skills, communication abilities, personal protective equipment use, psychological first aid, ethical-legal preparedness, clinical-technical skills, and leadership capabilities.
Conclusions
Substantial convergence exists around core disaster medicine competencies, yet significant variability persists in training approaches and duration. The establishment of globally recognized, evidence-based competency standards for individual disaster medical specialists represents a critical next step.
The stability of two bubbles rising initially in line through a viscous liquid is revisited using a global linear stability analysis formulated within an arbitrary Lagrangian–Eulerian framework, complemented by fully resolved embedded boundary method simulations. Whereas previous studies attributed the promoted in-line stability of oblate bubbles to a deformation-enhanced wake entrainment, the present analysis demonstrates that the dominant stabilizing mechanism arises instead from an inclination-induced rotational feedback generated as the trailing bubble (TB) experiences the asymmetric shear of the leading bubble’s wake. This inclination–shear coupling, rather than deformation itself, governs the recovery of stability with increasing aspect ratio. Furthermore, the results reveal that the unstable drafting–kissing–tumbling mode originates from short-range, two-way coupling between the bubbles, whereas the asymmetric side-escape mode corresponds to a long-range, one-way interaction dominated by the TB response. In addition, a previously unreported oscillatory global mode emerges from the unsteady recirculation linking the two bubbles, acting as a hydrodynamic spring whose effective stiffness and damping govern the oscillation frequency and growth rate. Together, these findings identify inclination-induced lift as the primary mechanism controlling the stability of rising bubble pairs and provide a unified framework for interpreting their stationary and oscillatory transitions across a broad range of inertial and deformable regimes.