This paper provides an account of a specific operation – the removal of the thymus gland (thymectomy) to treat the rare neurological condition myasthenia gravis – from its first performance in 1936, by the American surgeon Alfred Blalock, to the publication in 2016 of an international multicentre randomised controlled trial (RCT) of the technique. Thymectomy was the subject of a transatlantic controversy in the 1950s, in which the main players were the English surgeon Geoffrey Keynes, and American neurologists and surgeons from New York, Boston, and the Mayo Clinic. The resolution of this controversy involved the use of increasingly sophisticated statistical techniques, but also crucially other influences including the social transformation of thoracic surgery, and competition between the leading American centres. The consensus achieved after this controversy was challenged in the late 1970s, eventually prompting the implementation of a trial acceptable to twenty-first-century evidence-based medicine. This account will demonstrate that surgical innovation in the period covered required increasing attention to the statistical basis of patient selection and outcome evaluation; that the processes of technical innovation cannot be regarded as separate from developments in the professional culture of surgery, and that one of the consequences of these changes has been the gradual eclipse of the prestigious autonomous surgeon.

Although a direct link between cardiac lymphatics and congenital heart disease (CHD) has not been established, research indicates that abnormalities in the cardiac lymphatic system are involved in several congenital disorders that present with cardiac defects. However, this contribution remains poorly understood and is still an emerging area of study. One theory proposes that abnormal lymphatic development, which can present as cystic hygroma or increased nuchal translucency, may give rise to heart defects such as coarctation of the aorta, hypoplastic left heart syndrome, or bicuspid aortic valves. The genetic pathways for the development of the cardiac lymphatic system and the heart’s major vessels may overlap; therefore, mutations in these genes could result in simultaneous defects in both systems. The close anatomical proximity between cardiac lymphatics and the great vessels of the heart suggests a “cause and effect” relationship, where an abnormality in one could affect the other and lead to congenital defects. Given that congenital heart disease is the most common birth defect in the United States, this systematic review, following Preferred Reporting Items for Systematic Reviews and Meta-Analyses guidelines, seeks to explore the potential link between cardiac lymphatics and CHD. Understanding this connection could have significant clinical implications by paving the way for new diagnostic approaches and therapeutic strategies for CHDs.

Soricidae is the most species-rich eulipotyphlan family since the Pliocene. Numerous Late Miocene soricids and plesiosoricids are well known from southern Europe. Localities from central Europe, despite being rare, historically have yielded better preserved material that reveals a great diversity. We here add to this existing record with the description of eight species from MN9- to MN12-aged localities of Slovakia (Paenelimnoecus repenningi, Paenesorex bicuspis, Isterlestes aenigmaticus n. gen. n. sp., Crusafontina endemica, Crusafontina kormosi, Amblycoptus jessiae, Asoriculus gibberodon, Petenyia dubia), alongside one species of Plesiosoricidae (Plesiosorex evolutus). The early occurrence of A. gibberodon and A. jessiae, the occurrence of Paenesorex, and the identification of Isterlestes aenigmaticus n. gen. n. sp., reinforce the hypothesis that the Pannonian region (south-eastern central Europe) was a source area for several soricid taxa (Allosoricinae, Anourosoricini, Soricini) during the Late Miocene.

UUID: https://zoobank.org/4466a6ea-4fc6-4a3b-88f8-dbe020f2292d

This study introduces an innovative deep learning method for intelligent healthcare emotion analysis, specifically targeting the recognition of pain based on facial expressions. The suggested approach combines cloud-based mobile applications, utilising separate front-end and back-end elements to optimise data processing. The main contributions consist of a Smart Automated System (SASys) that integrates statistical and deep learning methods to extract features, thereby guaranteeing both resilience and efficiency. Image preprocessing encompasses the tasks of detecting faces and normalising them, which is crucial for extracting features with high accuracy. The comparison of statistical feature representation using Histogram of Oriented Gradients and Local Binary Pattern, along with machine learning classifiers, against an enhanced deep learning-based approach with an integrated multi-tasking feature known as multi-task convolutional neural network, demonstrates encouraging outcomes that support the superiority of the convolutional neural network architecture. Statistical and deep learning-based classification scores, when combined, greatly enhance the system’s overall performance. The results of the experiments prove that the method is effective, outperforming traditional classifiers and exhibiting comparable accuracy to cutting-edge healthcare SASys.

Involuntary retirement has negative effects on an individual’s health and satisfaction with life. However, it remains unknown whether the recent European policy shift from early retirement towards extending working lives has impacted retirement voluntariness.

This study examines how socio-demographic factors affect retirement voluntariness, which is classified as ‘involuntary’ (e.g. being laid off), ‘voluntary’ (e.g. wanting to spend more time with family) or ‘regular’ (e.g. reaching the state pension age). The analysis is based on SHARE data (Survey of Health, Ageing and Retirement in Europe), covers ten European countries and differentiates between two retirement cohorts (1994–2004 and 2005–2015) during which the policy shift took place.

At the individual level, we find that gender and socio-economic status correlate with retirement voluntariness. At the company level, the sector of employment and job tenure also show an association with retirement voluntariness. The results indicate that, between the two cohorts, the share of those who experience their retirement as ‘regular’ has increased, while the share with ‘involuntary’ retirement has decreased. However, these shifts differ by educational groups, with a stronger increase of voluntary retirement for those with high education, suggesting a rise in social inequalities in retirement-transitions, likely owing to an accumulation of (dis)advantages over the lifecourse.

Let $H_n$ be the minimal number such that any n-dimensional convex body can be covered by $H_n$ translates of the interior of that body. Similarly $H_n^s$ is the corresponding quantity for symmetric bodies. It is possible to define $H_n$ and $H_n^s$ in terms of illumination of the boundary of the body using external light sources, and the famous Hadwiger’s covering conjecture (illumination conjecture) states that $H_n=H_{n}^s=2^n$. In this note, we obtain new upper bounds on $H_n$ and $H_{n}^s$ for small dimensions n. Our main idea is to cover the body by translates of John’s ellipsoid (the inscribed ellipsoid of the largest volume). Using specific lattice coverings, estimates of quermassintegrals for convex bodies in John’s position, and calculations of mean widths of regular simplexes, we prove the following new upper bounds on $H_n$ and $H_n^s$: $H_5\le 933$, $H_6\le 6137$, $H_7\le 41377$, $H_8\le 284096$, $H_4^s\le 72$, $H_5^s\le 305$, and $H_6^s\le 1292$. For larger n, we describe how the general asymptotic bounds $H_n\le \binom {2n}{n}n(\ln n+\ln \ln n+5)$ and $H_n^s\le 2^n n(\ln n+\ln \ln n+5)$ due to Rogers, Shephard and Roger, Zong, respectively, can be improved for specific values of n.

By constraining organic carbon (OC) turnover times and ages, radiocarbon (14C) analysis has become a crucial tool to study the global carbon cycle. However, commonly used “bulk” measurements yield average turnover times, masking age variability within complex OC mixtures. One method to unravel intra-sample age distributions is ramped oxidation, in which OC is oxidized with the aid of oxygen at increasing temperatures. The resulting CO2 is collected over prescribed temperature ranges (thermal fractions) and analyzed for 14C content by accelerator mass spectrometry (AMS). However, all ramped oxidation instruments developed to date are operated in an “offline” configuration and require several manual preparation steps, hindering sample throughput and reproducibility. Here we describe a compact, online ramped oxidation (ORO) setup, where CO2 fractions are directly collected and transferred for 14C content measurement using an AMS equipped with a gas ion source. Our setup comprises two modules: (i) an ORO unit containing two sequential furnaces, the first of which holds the sample and is ramped from room temperature to ∼900°C, the second of which is maintained at 900°C and holds catalysts (copper oxide and silver) to ensure complete oxidation of evolved products to CO2; and (ii) a dual-trap interface (DTI) collection unit containing two parallel molecular sieve traps, which alternately collect CO2 from a given fraction and handle its direct injection into the AMS. Initial results for well-characterized samples indicate that 14C content uncertainties and blank background values are like those obtained during routine gas measurements at ETH, demonstrating the utility of the ORO-DTI setup.

In recent decades, analysing the progression of mortality rates has become very important for both public and private pension schemes, as well as for the life insurance branch of insurance companies. Traditionally, the tools used in this field were based on stochastic and deterministic approaches that allow extrapolating mortality rates beyond the last year of observation. More recently, new techniques based on machine learning have been introduced as alternatives to traditional models, giving practitioners new opportunities. Among these, neural networks (NNs) play an important role due to their computation power and flexibility to treat the data without any probabilistic assumption. In this paper, we apply multi-task NNs, whose approach is based on leveraging useful information contained in multiple related tasks to help improve the generalized performance of all the tasks, to forecast mortality rates. Finally, we compare the performance of multi-task NNs to that of existing single-task NNs and traditional stochastic models on mortality data from 17 different countries.

Several breast microwave sensing (BMS) systems have shown encouraging results as a potential breast cancer detection tool. The existing systems in the literature have diverse designs, equipment, measurement protocols, and analysis methods. However, there is relatively little investigation on the impact and performance of varying system designs. This work compares the impact of system design parameters on three existing BMS systems. The first system, a bed-based system, was designed for use in a permanent clinic. The second system, a bench-top system, was created for laboratory research. The third system, a portable system, was designed for use in low-income and remote communities. The bed-based system had the highest resolving capabilities, achieving a spatial resolution of 12.4 ± 0.5 mm. Additionally, the bed system had the highest signal-to-noise ratio of 26 ± 1 dB. The portable system had the least intensity dependence on polar positions within the imaging chamber. The bed system had the highest contrast between tumor- and adipose-mimicking materials. However, the contrast of tumor- and fibroglandular-mimicking materials was similar for each system. By comparing and evaluating the performance of multiple BMS systems, we improve our understanding of system design, allowing for potential studies into an ideal BMS system.

Research on the association between the Chinese visceral adiposity index (CVAI) and hyperuricaemia (HUA) is scarce, and whether the association differs by sex is unclear. This research aimed to explore sex-specific associations between CVAI and HUA and to compare CVAI’s predictive performance with other adiposity indices using data from 22 171 adults (30–79 years) in the China Multi-Ethnic Cohort study (Chongqing region). The prevalence of HUA was 20·9 % in men and 9·7 % in women. Multivariable logistic regression analyses were utilised to assess the adjusted OR and 95 % CI. After multivariable adjustment, CVAI was associated with HUA in men (OR Q4 v. Q1 = 3·31, 95 % CI 2·73, 4·03) and women (OR Q4 v. Q1 = 7·20, 95 % CI 5·12, 10·12). Moreover, significant interactions were observed between BMI and CVAI on HUA in both sexes (all Pinteraction < 0·001), with the strongest associations in those with BMI < 24·0 kg/m2. The OR (95 % CI) across different BMI groups (< 24·0, 24·0–27·9, ≥ 28·0 kg/m²) were 1·87 (1·63, 2·13), 1·65 (1·48, 1·85) and 1·30 (1·14, 1·49) for men and 2·76 (2·18, 3·51), 2·46 (1·98, 3·07) and 1·87 (1·47, 2·39) for women, respectively. Additionally, CVAI showed satisfactory predictive performance for HUA in women, with the largest area under the receiver operating characteristic curve of 0·735, but not in men (0·660). These findings suggest a close association between CVAI and HUA, particularly pronounced in those with BMI < 24·0 kg/m², and a stronger association in women than in men.

In this paper, by means of upper approximation operators in rough set theory, we study representations for sL-domains and its special subclasses. We introduce the concepts of sL-approximation spaces, L-approximation spaces, and bc-approximation spaces, which are special types of CF-approximation spaces. We prove that the collection of CF-closed sets in an sL-approximation space (resp., an L-approximation space, a bc-approximation space) ordered by set-theoretic inclusion is an sL-domain (resp., an L-domain, a bc-domain); conversely, every sL-domain (resp., L-domain, bc-domain) is order-isomorphic to the collection of CF-closed sets of an sL-approximation space (resp., an L-approximation space, a bc-approximation space). Consequently, we establish an equivalence between the category of sL-domains (resp., L-domains) with Scott continuous mappings and that of sL-approximation spaces (resp., L-approximation spaces) with CF-approximable relations.

An area-preserving homeomorphism isotopic to the identity is said to have rational rotation direction if its rotation vector is a real multiple of a rational class. We give a short proof that any area-preserving homeomorphism of a compact surface of genus at least two, which is isotopic to the identity and has rational rotation direction, is either the identity or has periodic points of unbounded minimal period. This answers a question of Ginzburg and Seyfaddini and can be regarded as a Conley conjecture-type result for symplectic homeomorphisms of surfaces beyond the Hamiltonian case. We also discuss several variations, such as maps preserving arbitrary Borel probability measures with full support, maps that are not isotopic to the identity and maps on lower genus surfaces. The proofs of the main results combine topological arguments with periodic Floer homology.

This article examines the ways in which the Sino-Canadian relationship has shaped Canadian legal structures and vice versa. The Canadian state’s anxieties about Chinese foreign policy have led to the “securitization” of various domains of domestic law, whereby the state has emphasized the national security implications of legal concepts, decisions, and regimes. This securitization may fuel discrimination towards Chinese Canadians, and the article suggests reforms that the Canadian state can adopt as it seeks to simultaneously implement a robust China strategy and avoid the mistreatment of Chinese Canadians.

Delphi studies allow for the generation of a consensus among experts. This has historically been professional experts in their field. This study aimed to obtain a consensus regarding the most important components of cognitive behavioural therapy (CBT) for depression not only for professional experts (therapists) but also for adult experts by experience. Perceptions of importance between therapists and experts by experience differed in multiple areas including content components such as behavioural activation and experiments, psychoeducation, and homework, which the latter did not agree were important. Experts by experience found several components relating to delivery process important which therapists did not, such as delivery method and session length. The strongest agreement from both groups involved the importance of positive therapist factors such as being non-judgemental, knowledgeable, understanding, and trustworthy. Both groups were in agreement on the importance of cognitive restructuring. Neither experts by experience nor therapists met consensus agreement on the inclusion of mindfulness as part of a wider CBT intervention for depression, being rated among the lowest components for both groups. Findings highlight several aspects of CBT content and delivery which may benefit from review in order to increase acceptability for recipients.

Key learning aims

1. (1) To identify what recipients and deliverers feel are the most important parts of a CBT intervention for depression.

2. (2) To compare these responses, and consider reasons why these similarities and differences may exist.

3. (3) To discuss ways in which these differences could impact acceptability and perceived efficacy of cognitive behavioural therapy.

4. (4) To reflect on ways gained knowledge could be used to consider ways to improve the delivery of cognitive behavioural therapy.