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Despite growing interest in novel treatments for anorexia nervosa, outcomes remain poor – often not because existing interventions are inherently ineffective, but due to systemic barriers that hinder their delivery. Written by a person with lived experience, this article critiques the prioritisation of innovation over implementation, highlighting how funding structures, methodological limitations and ethical practices in research can exacerbate inequalities and constrain real-world impact. It explores the untapped potential of existing treatments, the ethical complexities of researching anorexia nervosa and the risks of reinforcing false dichotomies – such as those between old and new, promise and futility, and body and mind. The paper argues for an integrated approach that values both innovation and refinement, closing current gaps in knowledge and treatment through greater collaboration across disciplines. Recommendations are made to support the orientation of research and care systems towards more effective, personalised and just treatment for anorexia nervosa.
The aerodynamic sound generated by the oblique collision of two vortex rings is featured by the asymmetric emission associated with the octupole mode, which differs from the symmetric emission associated with the quadrupole mode observed in the coaxial collision of two vortex rings. This distinctive feature of aerodynamic sound is closely related to the tilting and reconnecting of the vortex rings. While previous studies have explored the effects of reconnecting on aerodynamic sound, this study specifically addresses the impact of vortex ring tilting. We propose a novel vortex sound formula to quantitatively assess the role of tilting in aerodynamic sound generation. The proposed formula relates the far-field sound pressure to equivalent circulations and vorticity centroids by referring to Truesdell’s consistency conditions for vorticity moments. The variations of the equivalent circulations and vorticity centroids in the oblique collision of two vortex rings under different configurations are analysed based on the numerical solution of the Navier–Stokes equations in the source region. It is found that the tilting of vortex rings results in a rapid change of the equivalent circulation associated with the vorticity in the collision direction. However, the change caused by titling is almost out of phase with that caused by reconnecting and deforming. The vortex tilting significantly reduces the aerodynamic sound associated with the longitudinal quadrupole and octupole modes, which is opposite to the role of vortex reconnecting that was reported in the oblique collision of vortex rings.
Woodrats of the genus Neotoma are an important study system for ecological and paleoecological research. However, paleontological studies are often hindered by the difficulty of identifying woodrat remains to species. We address this limitation by using 2D landmark-based geometric morphometrics to classify 199 lower first molars (m1s) of five extant western North American Neotoma species (N. albigula, N. cinerea, N. fuscipes, N. lepida, and N. macrotis) collected throughout California. We then use discriminant analysis of principal components (DAPC) models to identify Late Pleistocene fossils of unknown species from the Rancho La Brea Tar Pits in Los Angeles, California. DAPC correctly identifies ∼85–90% of extant individuals to species, with most misclassifications occurring between sister taxa N. fuscipes and N. macrotis. Most fossil m1s are classified as N. macrotis by DAPC, which may be the first confirmation of N. macrotis in the fossil record. We show that landmark-based geometric morphometric analyses are generally effective at differentiating m1s of extant Neotoma species in California and they are an auspicious method for unknown fossil identification. Further applications of this method across a broader range of geographic locations and species will better contextualize its utility.
3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy (MDMA-AT) has shown promising safety and efficacy in phase 3 studies of post-traumatic stress disorder, but has not been investigated for a primary diagnosis of major depressive disorder (MDD).
Aim
We aimed to explore the proof of principle and safety as a first study with MDMA-AT for MDD, and to provide preliminary efficacy data.
Method
Twelve participants (7 women, 5 men) with moderate to severe MDD received MDMA in 2 open-label sessions 1 month apart, along with psychotherapy before, during and after the MDMA sessions, between January 2023 and May 2024. The primary outcome measure was mean change in Montgomery–Asberg Depression Rating Scale (MADRS), and the secondary outcome measure was mean change in functional impairment as measured with the Sheehan Disability Scale (SDS), both from baseline to 8 weeks following the second MDMA session. We used descriptive statistics and the two-tailed Wilcoxon signed-rank test to compare baseline and outcome scores. Repeated measures were analysed by a mixed-effects model.
Results
Baseline MADRS was 29.6 (s.d. 4.9). Feasibility was demonstrated with sufficient recruitment and retention. MADRS scores were significantly reduced post treatment compared with baseline (mean difference –19.3, s.e. 2.4, CI –14.8 to –23.8, P < 0.001). SDS scores significantly decreased from baseline (mean difference –11.7, s.e. 2.2, CI –7.5 to –15.9, P = 0.001). There were no adverse events of special interest, and no unexpected or serious adverse events.
Conclusion
The study met the primary objectives of safety and feasibility, and provided indications of efficacy for MDMA-AT for MDD. Further studies with a randomised design are required to confirm these findings.
In the early 2000s, Ramakrishna asked the question: for the elliptic curve
\[E\;:\; y^2 = x^3 - x,\]
what is the density of primes p for which the Fourier coefficient $a_p(E)$ is a cube modulo p? As a generalisation of this question, Weston–Zaurova formulated conjectures concerning the distribution of power residues of degree m of the Fourier coefficients of elliptic curves $E/\mathbb{Q}$ with complex multiplication. In this paper, we prove the conjecture of Weston–Zaurova for cubic residues using the analytic theory of spin. Our proof works for all elliptic curves E with complex multiplication.
We prove a Poisson process approximation result for stabilising functionals of a determinantal point process. Our results use concrete couplings of determinantal processes with different Palm measures and exploit their association properties. Second, we focus on the Ginibre process and show in the asymptotic scenario of an increasing observation window that the process of points with a large nearest neighbour distance converges after a suitable scaling to a Poisson point process. As a corollary, we obtain the scaling of the maximum nearest neighbour distance in the Ginibre process, which turns out to be different from its analogue for independent points.
In recent years, the removal of orbital debris has become an increasingly urgent task due to advancements in human space exploration. Capturing space debris through caging manipulation offers notable advantages in terms of robustness and controllability. This paper proposes a configuration-based caging manipulation design method for a cable-driven flexible arm. First, the cable-driven flexible arm with multi self-lockable links is introduced. To quantify the caging configurations formed by different self-lockable link selections, a novel planar caging quality metric is then presented for arbitrary planar objects. Using this metric, a caging design method is developed for the flexible arm to conduct caging manipulations. Finally, the caging manipulation strategies are discussed with lock selection maps for different objects, and a robust caging strategy considering uncertainty is further explored. Simulation and experimental results validate the effectiveness of the proposed caging design method and demonstrate better performance compared to conventional caging methods.
Background: Normalized growth curves are an essential component in management of pediatric patients. Benign enlargement of subarachnoid spaces (BESS) is a common condition in infants that results in deviation from expected head growth but does not have long term implications. Differentiating BESS from pathological conditions is critical to minimize unnecessary imaging and specialist evaluations. Standardized growth charts specific to BESS do not exist, complicating monitoring and management. Methods: An analysis of head circumference (HC) data was performed for 315 children aged 0-6 years diagnosed with BESS at CHEO. Growth charts were created using Generalized Additive Models for Location, Scale, and Shape (GAMLSS). Z-scores derived from HC measurements were compared to World Health Organization (WHO) norms, stratified by sex. Results: Benign macrocephalic patients consistently tracked above the 97th percentile of WHO curves, with the 50th percentile in this cohort aligning with the 97th percentile of WHO data. HC growth accelerated in early infancy, stabilizing around ages 2-3. Growth charts demonstrated distinct patterns for BESS compared to normative data. Conclusions: This study provides novel charts for BESS, enabling improved monitoring and clinical management. These charts have the potential to reduce unnecessary imaging and specialist referrals, alleviating anxiety for caregivers and clinicians while optimizing resource use.
This project aims to identify and explain a phenomenon I call pain-related motivational deficit, which occurs when there is proper uptake of the epistemic contributions of a pain utterance, but defective uptake of the motivational contributions of a pain utterance. I argue that the normalization of fibroid pain in Black women, and of menstrual pain more broadly, causes a pain-related motivational deficit to be unfairly assigned to utterances about these pain experiences. I show that current ways of thinking about epistemic injustice cannot adequately explain these cases.
After dispensing major precedents affecting the public’s health in each of its prior three terms, the 2024-2025 term of the US Supreme Court was arguably less impactful amid several unanimous decisions preserving existing jurisprudence (at least in part). However, this is an understatement. While the Court issued key decisions arguably favorable to communal health this prior year it also denied minors access to medical procedures sought by their doctors, diminished diversity, equity, and inclusion (DEI) initiatives in employment, allowed states to deny health providers access to Medicaid because they also provided abortions, disallowed rural hospitals from collecting specific costs for treating low-income patients, and provided a “script” of sorts for executive control of federal health advisory committees.
Background: Aplasia Cutis Congenita is a rare congenital abnormality characterized by varying absence of skin and mesodermal tissues. Management remains controversial, with significant inconsistency across specialties and over time. This review evaluates trends in management based on journal specialty and publication epoch. Methods: A review of pediatric scalp Aplasia Cutis Congenita management was conducted. Articles were categorized by journal type (neurosurgery, plastic surgery, dermatology, other medical, and other surgical) and management approach (surgical, conservative, or combined). Descriptive statistics were used to summarize trends in recommendations, and assess associations between journal type and treatment. Trends over time were analyzed based on publication year. Results: A total of 171 studies were included. Among surgical journals, 33.7% recommended surgical management, while medical journals favored conservative (14.1%) or combined approaches (84.5%) (p < 0.001). Recommendations for surgical management decreased from 80% in the 1970s to 30% in the 2020s. Notably, among 119 studies advocating for a combined approach, only 27 provided criteria for surgical indications, with lesion thresholds ranging from >1cm to >15 cm. Conclusions: This study highlights the lack of guidelines for ACC management and reveals specialty and time epoch of publication-dependent biases in treatment. These findings emphasize the need for multidisciplinary guidelines for consistent, patient-centered care.
A local food-based approach, including school-lunch (SL) with multiple-micronutrient fortified biscuits (MMB) as supplementary snacks, may enhance dietary adequacy, although current data is sparse on this strategy. This study evaluated nutrient inadequacies in adolescent girls and evaluated food-based dietary recommendations (FBRs), incorporating SL from the Ghana School Feeding Programme (GSFP) and MBB. Data from 292 girls aged 10-17 were analysed as part of the Ten2Twenty-Ghana study using a quantitative 24-hour dietary recall. Model parameters included non-condiment foods consumed by at least 5% of the girls, median serving sizes, intake frequency, energy and nutrient content, and cost per 100g. Constraints were based on estimated energy intake and population reference nutrient intakes defined by harmonized average requirements (H-AR). Usual energy and nutrient intakes and the prevalence of nutrient inadequacies were estimated using the National Cancer Institute method. Optifood Linear Programming tool was used for FBRs. The mean usual energy intake was 2351±66 kcal/day. Calcium (99.8%), vitamin B12 (99.8%), riboflavin (96.2%), vitamin A (91.5%), vitamin C (87.6%), iron (73.7%), folate (49.3%), and zinc (8.5%) inadequacies were prevalent. Optimised-diets achieved adequacy for protein and most micronutrients, except calcium and vitamin B12, besides vitamin A for 15-17-years girls. SL from the GSFP did not enhance micronutrient levels when added to daily diet. Adding MMB to daily diet ensured adequacy for vitamin C, riboflavin, and iron, although marginal for iron. Calcium and vitamin A improved substantially with MMB for girls aged 15-17 but remained below the H-AR. Integrating regular SL with specialized fortified-foods may be a cost-effective strategy to enhance dietary adequacy for adolescent girls in rural areas.
Background: Minimally invasive endoscopic techniques via the transorbital approach (ETOA) is emerging as an alternative approach for addressing skull base tumours. This study aims to showcase our institution’s 8 year experience in using ETOA, detailing the surgical technique employed and presenting comprehensive patient outcomes. Methods: A retrospective analysis was conducted on data from 32 patients who underwent ETOA within the past eight years. Demographic data was obtained as well as information on surgical approaches, intra-operative findings, recurrence and complications. Results: 33 ETOA procedures were performed on 29 patients, with an average age of 45, 14 of whom were women. The superior orbital corridor was utilized in 100% of cases, and in 79.17%, ETOA was complemented by a transnasal approach. Spheno-orbital meningioma accounted for the most common surgical indication (36.36%, n=12, followed by lateral frontal sinus mucocele (18.75%, n=6). The median length of stay was one day.Transient V1 numbness was the primary complication (33%, n=8), and 18.75% (n=6) necessitated another surgery. Notably, no mortality was associated with this procedure. Conclusions: Our institution’s experience underscores the notable safety and effectiveness of ETOA, The main complications being transient V1 numbness, proptosis, transient diplopia. Revision surgery was only required in 6 out of 33 cases.
Background: Nipocalimab (a fully human, effectorless anti-neonatal Fc receptor (FcRn) monoclonal antibody) may ameliorate gMG disease manifestations by selectively targeting FcRn IgG recycling and lowering IgG, including pathogenic autoantibodies in generalized myasthenia gravis (gMG). The objective was to evaluate the effectiveness and safety of intravenous nipocalimab added to background standard-of-care therapy in adolescents with gMG. Methods: Seropositive patients (12-<18 years) with gMG (MGFA Class II-IV) on stable therapy but inadequately controlled, were enrolled in a 24-week open label study. Nipocalimab was administered as a 30 mg/kg IV loading dose followed by 15 mg/kg IV every 2 Weeks. Results: Seven adolescents were enrolled; 5 completed 24-weeks of dosing. The mean(SD) age was 14.1(1.86) years; seven were anti-AChR+, six were female. Mean(SD) baseline MG-ADL/QMG scores were 4.29(2.430)/12.50(3.708). Nipocalimab showed a significant reduction in total serum IgG at week-24; the mean(SD) change from baseline to week-24 for total serum IgG was -68.98%(7.561). The mean(SD) change in MG-ADL/QMG scores at week-24 was -2.40(0.418)/-3.80(2.683); 4 of 5 patients achieved minimum symptom expression (MG-ADL score 0-1) by week-24. Nipocalimab was well-tolerated; there were no serious adverse events. There were no clinically meaningful laboratory changes. Conclusions: Nipocalimab demonstrated efficacy and safety in this 6-month trial in seropositive adolescents with gMG.