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Lewin and colleagues’ article in this journal gives a good overview of how artificial intelligence (AI) is contributing to the reshaping of mental healthcare. However, a deeper focus on the synergies between different approaches to AI and its goals is needed. This commentary aims to further consider the unique implications of digital mental health approaches, including predictive, explainable and generative AI, for both research and clinical objectives.
CHD are structural cardiac anomalies which are a leading cause of childhood mortality and morbidity in India and have multifactorial aetiology. Compromised socioeconomic status augments several environmental stressors and is shown to have a positive association with CHD in offspring. The presented study is an institution-based case-control study to explore the same with CHD as the primary outcome.
Methods:
A total of 2064 paediatric patients (1760 CHD cases and 304 controls with structurally normal hearts) were analysed. Demographic and socioeconomic status parameters were recorded using the Kuppuswamy scale. Statistical associations were examined using chi-square tests and odds ratios.
Results:
Majority of all patients belonged to the upper-lower class. No significant association was found between socioeconomic status and CHD (p = 0.18). However, rural residence was significantly associated with a higher risk of CHD (χ2 = 16.09, p = 0.0011; OR vs. urban = 1.59). A significant association was found between maternal education and CHD prevalence (χ2 = 20.9, p = 0.0001), with uneducated mothers having higher odds of children with CHD. Joint family structure also showed higher odds of having a child with CHD (OR = 1.75, p < 0.001).
Conclusion:
While socioeconomic status alone was not significantly associated with CHD in this cohort—likely due to universal free care at our institute—maternal education, rural residence and family structure emerged as critical determinants. These findings highlight the need for targeted public health initiatives focusing on maternal literacy, rural healthcare access, and awareness programmes to improve early CHD diagnosis and outcomes. Further population-based research is needed to elucidate socioeconomic status-CHD associations at a broader level.
This essay examines the Army’s efforts to cultivate and gain congressional support for the GI Bill in the 1980s. Focusing on the relationship between Representative Sonny Montgomery, senior Army leaders like Maxwell R. Thurman and Robert Elton, and the staffers who worked for each of them, it illustrates the intentionality with which Army leaders worked to cultivate congressional support for and to head off congressional and presidential opposition to a bill that they saw as essential. Analyzing their public and private efforts at critical moments when the legislation was imperiled reveals that relations between the Army and Congress are more intricate than testimony at hearings and budget requests might reveal, that throughout the 1980s, Army leaders remained deeply concerned about sustaining the All-Volunteer Force, and that the ultimate success of that force and the legislation that helped ensure it rested with individuals who built and then leveraged personal relationships.
A chemical explosion and fire erupted in Conakry, Guinea, West Africa on December 18, 2023, destroying Guinea’s main fuel depot and resulting in 25 dead and 459 injured. Fifteen of the deaths occurred directly at the explosion site. Firefighters initiated efforts to control the blaze and transported injured, non-ambulatory victims to local hospitals with assistance from the military, Red Cross, and mining companies. Thirteen clinical facilities within an eight-mile radius of the explosion received burn and non-burn victims, with only one of these, Donka National Hospital, capable of handling burn victims. Many less seriously injured victims self-selected where they sought care, although anecdotal information indicates that an unknown number of injured did not seek care or chose to leave the city. The disaster marked the first time stakeholders from various sectors in the Guinean society (from first responders to mining companies) came together in a concerted response. Ranked 179th of 193 countries on the Human Development Index (HDI), the disaster rapidly outstripped Guinea’s response and health care capabilities, leaving behind economic shocks affecting livelihoods and the local economy. These experiences underscore the need for improved capabilities and coordination in disaster planning, warning and communication systems, and prehospital and hospital response in developing countries.
Neurodivergence encompasses neurodevelopmental conditions including autism, attention-deficit hyperactivity disorder (ADHD) and Tourette syndrome. Particular physical traits, notably those linked to joint hypermobility, have an established association with both neurodivergence and bipolar affective disorder.
Aims
This case-control study tested, first, whether the presence of joint hypermobility predicted bipolar affective disorder and, secondly, whether neurodivergent characteristics were important in understanding this relationship.
Method
Data were collected from 52 participants with self-reported clinical diagnoses of bipolar affective disorder and from a comparison group of 54 participants without diagnosis of bipolar affective disorder. All participants were assessed on screening instruments for autism (Ritvo Autism Asperger Diagnostic Scale; RAADS-R), ADHD (Wender Utah Rating Scale; WURS) and joint hypermobility. Group differences were explored, and odds ratios calculated for the presence of bipolar and neurodivergence given the presence of hypermobility. A mediation analysis was performed to determine the contribution of neurodivergent characteristics to the relationship between joint hypermobility and bipolar affective disorder.
Results
The presence of joint hypermobility significantly predicted the presence of bipolar disorder (odds ratio 5.1; 95% CI = 2.1, 12.4). In the bipolar affective disorder group, the prevalence of likely autism and ADHD was greater (84.6 and 65.4% respectively) than in the comparison group (22.2 and 3.7% respectively). The odds ratio for a diagnosis of bipolar affective disorder was 18.2 (95% CI = (6.70, 49.41)) in those meeting the threshold for likely autism; and 46.89 (95% CI = 9.96, 220.74) in participants meeting the threshold for likely ADHD. Mediation analysis showed that autistic, ADHD and pooled neurodivergent characteristics mediated the link between joint hypermobility and bipolar affective disorder.
Conclusions
This suggests a potential mechanism for affective pathophysiology, through developmental characteristics associated with joint hypermobility. The appreciation of interacting physical and neurodivergent traits to the expression of psychiatric illness has implications for diagnostic formulation, personalised medicine and service design.
This study was conducted to investigate the effects of blended oils with a balanced n-6/n-3 PUFA ratio of 6:1 and unsaturated fatty acid/SFA (UFA/SFA) ratio of 2·5:1 on growth performance and intestinal health in lipopolysaccharide (LPS)-challenged piglets. One hundred and twenty piglets were selected and randomly assigned to two treatments (2 % soybean oil or 2 % blended oils). On day 28, the experiment was conducted as a 2 × 2 factorial arrangement of treatments, including dietary treatment (2 % soybean oil v. 2 % blended oil) and LPS challenge (saline v. LPS). The results showed that the blended oils supplementation increased average daily gain and average daily feed intake during 1–14 d (P < 0·05), and reduced feed to gain ratio in the whole experimental period (P < 0·05). In addition, the blended oils supplementation improved intestinal morphology, increased maltase and sucrase activities and alleviated inflammation response in the intestine. Moreover, the blended oils supplementation increased proliferating cell nuclear antigen mRNA expression in jejunum and Ki67 mRNA expression in ileum (P < 0·05) in both saline-treated piglets and LPS-challenged piglets. The blended oils reduced C-myc and caspase-3 mRNA expressions and increased Axin2 and Cyclin d1 mRNA expressions after LPS challenge (P < 0·05). In conclusion, the blended oils can improve growth performance and promote intestinal health in piglets.
Social connections might be protective against depressive and anxious symptoms and dementia in later life. The extent to which social connections are heritable versus modifiable in older age remains unknown.
Aims
We aimed to investigate the heritability of social connections and their influence on mental and cognitive health over time among older adults in a longitudinal cohort.
Method
We analysed data from the Older Australian Twins Study (333 monozygotic, 266 dizygotic twins; 65+ years) at three time-points over 6 years. We examined the factor structure and heritability of baseline social connections and their associations with mental and cognitive health longitudinally.
Results
We found three weakly heritable social connections factors: (a) interacting with friends/neighbours/community (h2 = 0.09, 95% CI: 0.00, 0.44); (b) family interactions/childcare (h2 = 0.13, 95% CI: 0.00, 0.43); (c) involvement in religious groups/caregiving (h2 = 0.00, 95% CI: 0.00, 0.19). Strong genetic correlations were observed between depressive symptoms and factors a (r = −0.96) and b (r = −0.60). More frequent baseline interactions with friends/neighbours/community were associated with fewer depressive symptoms cross-sectionally (B = −0.14, p = .004) and longitudinally (B = −0.09, p = 0.006), but the associations between social connections and cognitive health were not significant.
Conclusions
Social connections were weakly heritable, suggesting large environmental determination. Connections with friends/neighbours/community were associated with better mental health cross-sectionally and over time.
This study aims to evaluate differences in healthcare utilization among patients with ischemic stroke in metropolitan versus non-metropolitan Manitoba.
Methods:
This study is a population-level analysis using the Discharge Abstract Database from Manitoba. The database includes all patients who received care in a Manitoba facility for ischemic stroke between April 2019 and March 2023. Data were collected on patient demographics, comorbidities and geographical location of stroke presentation (metropolitan Winnipeg vs non-metropolitan). Outcomes included length of stay (LOS), treatment, discharge disposition and mortality. Regression analysis was performed to analyze outcomes, adjusting for age, sex and comorbidities.
Results:
3704 (71.6%) patients were admitted in Winnipeg, and 1471 (28.4%) patients were admitted in non-metropolitan Manitoba. Patients presenting to Winnipeg were younger (mean age 72.3 vs 74.3 years) and had higher rates of atrial fibrillation, hypertension, diabetes, chronic kidney disease and heart failure. Patients presenting to Winnipeg had a shorter LOS (16.1 days vs 18.4 days, coefficient 0.05, 95% CI −4.54 to −1.27), had higher rates of intravenous thrombolysis (adjOR 5.13, 95% CI 3.85–6.84), were less likely to be discharged home (39.8% vs 57.5%, adjOR 0.47, 95% CI 0.41–0.53) and were more likely to be transferred for inpatient stroke rehabilitation (adjOR 3.46, 95% CI 2.64–4.54). There were no differences in in-hospital mortality. There was a higher incidence of stroke in Winnipeg compared to non-metropolitan Manitoba (F-statistic 23.84, p = 0.0028).
Conclusions:
This study illustrates differences in healthcare utilization outcomes between patients living in metropolitan Winnipeg versus non-metropolitan Manitoba presenting with ischemic stroke.
This study presents the integrated results of stable carbon (δ13C) and nitrogen (δ15N) isotope and aDNA analyses, conducted to examine dietary and mobility practices in two mid- to late Byzantine communities in western Anatolia: the coastal cosmopolitan site of Kadıkalesi Anaia and the rural inland settlement of Barcın Höyük. Isotopic data from thirty-eight individuals indicate that both populations primarily consumed terrestrial C₃-based resources. At Kadıkalesi, δ15N values show greater variability, suggesting more differentiated access to animal protein sources, whereas the rural community at Barcın Höyük exhibits isotopic homogeneity, consistent with more uniform dietary practices and an equitable access to food. Kadıkalesi also shows intra-site dietary variation by age and sex, while Barcın is again more homogeneous. At Barcın, aDNA results indicate a predominant local genetic continuity, suggesting a stable population; a single instance of external ancestry is attested by a male individual with affinities to western populations, particularly from eastern Europe, in line with historical military resettlement patterns (stratiotika ktemata). By integrating isotopic and genomic evidence, this study demonstrates how ancestry and mobility shaped dietary habits, offering insights into the interplay of urbanism, mobility, and social organization in the Byzantine period.
The Supreme Court is less constrained than political science has recognized. Motivated justices can dramatically alter politics without deferring to actors in the other branches. Subverting constraints, justices can aggrandize power and impose their irreducible preferences. Using Reconstruction as an example, this article brings new evidence to support the claim that an autonomous Court precipitated the end of Reconstruction. I make three essential arguments: First, the Republican commitment to federal civil rights protection extended longer than is traditionally supposed. Second, the architect of postbellum constitutionalism, Justice Bradley, harbored long-standing fear of Black equality and enfeebled the Reconstruction amendments when neither legal nor political imperatives compelled him to do so. Last, Bradley’s interventions substantially hindered Reconstruction by facilitating the “redemption” of southern state governments. This article employs mixed-methodology, using a difference-in-differences analysis and novel archival data. Contrary to scholarship arguing that the Court simply followed a Republican retreat, the Court dramatically reshaped the political-social development of Reconstruction.
Le 8 juin 2023, le Canada et les Pays-Bas ont saisi la Cour internationale de justice (CIJ) pour des violations de la 1984 Convention contre la torture et autres peines ou traitements cruels, inhumains ou dégradants attribuées à l’État syrien. À cette situation étatique, souvent décrite comme une zone où le droit et la justice n’avaient pas leur place, se superposent ainsi de premiers efforts pour que l’État rende des comptes. Au-delà de la possibilité dont dispose la Cour internationale de Justice (CIJ), en tant que visage institutionnel de la responsabilité étatique, de réduire ici le “fossé d’impunité,” cette affaire met également en lumière la tension existante entre deux visions opposées du droit international (“universaliste” et “souverainiste”) qui sont appelées à coexister dans le cadre de la lutte contre l’impunité. Bien que cette affaire, s’inscrivant dans une lignée jurisprudentielle favorable à l’élargissement de la fonction judiciaire de la CIJ, confirme la proximité avec le modèle “universaliste” eu égard à l’extension du locus standi devant son prétoire et à l’évolution de son mandat pour embrasser les contextes gouvernés par des violations massives des droits de la personne, il ne faudrait pas en déduire que le paradigme “souverainiste” a été effacé et remplacé.
Twin fetuses show a physiologically slower growth rate in the third trimester compared to singletons. Therefore, it has been suggested that the anthropometric evaluation of twins at birth should be performed using twin-specific charts. To be reliable, anthropometric charts need to fulfil certain methodological criteria to systematically review studies that have developed neonatal twin-specific anthropometric charts and assess their methodological quality. A comprehensive search was conducted across Cinahl, Embase, Global Index Medicus, PubMed, Scopus, Web of Science, Google Scholar, and relevant preprint repositories, followed by a predefined snowballing search. Two reviewers independently screened studies for eligibility, selecting those that have developed cross-sectional anthropometric charts for twins at birth, published since January 1990. Articles were excluded if they did not use anthropometric measurements at birth to construct charts. Two reviewers independently extracted data and performed quality assessment with a 16-item grading system. Sixty-eight studies were included, with all but one constructed reference, not standard, charts. Most studies did not meet the quality criteria: only 9% were prospectively designed, 34% reliably estimated gestational age, 19% reported standardized instruments, 28% described measurement techniques, and 26% did not stratify centiles by sex. This review reveals considerable methodological limitations in existing twin-specific neonatal anthropometric charts.
The optically stimulated luminescence (OSL) sensitivity of quartz ranges across five orders of magnitude. Previous studies suggested that quartz OSL sensitivity is enhanced by solar exposure–burial irradiation cycles. Spatially resolved luminescence measurements and laboratory illumination–irradiation experiments were used to investigate the OSL sensitivity of quartz crystals from a granodiorite cobble and quartz grains from a fluvial sand. Quartz from the granodiorite cobble has low OSL sensitivity, showing an approximately linear sensitization path that resulted from laboratory illumination–irradiation cycles. The mean OSL sensitivity of quartz sand grains (100 grains) increased from ∼40 to 80 counts after 1260 illumination–irradiation cycles. Each grain has a specific sensitization trajectory due to illumination–irradiation cycles, suggesting that quartz crystal composition heterogeneities drive the OSL sensitization of their daughter sediment grains. Maximum OSL sensitivity of quartz sand grains is reached after illumination–irradiation cycles representing an accumulated dose of around 4000 Gy. This dose corresponds to sediment burial time of 2–4 Ma, which is unlikely to occur during a single sediment transport route. This study suggests that illumination–irradiation cycles are unable to produce quartz sand grains with OSL sensitivity up to five orders of magnitude higher than the sensitivity of parent crystals in igneous or metamorphic rocks.
This paper studies efficiency in the housing market in the presence of search frictions and endogenous entry of buyers and sellers. These two features are essential to explain the housing market stylized facts and to generate an upward-sloping Beveridge Curve in the housing market. Search frictions and endogenous entry create two externalities in the market. First, there is a congestion externality common to markets with search frictions. Sellers do not internalize the effect of listing a house for sale on other sellers’ probability of finding a buyer. Second, the endogenous entry of buyers leads to a participation externality, as new entrants in the market raise search costs for all buyers. The equilibrium is inefficient even when the Hosios-Mortensen-Pissarides condition holds. Using a calibration to the US housing market, we quantify the size of these externalities and how far the housing market is from the optimal allocation. The optimal vacancy rate and time-to-sell are about half their equilibrium counterparts, whereas the optimal number of buyers and homeowners are above their decentralized equilibrium values. Finally, we investigate how housing market policies restore efficiency in the housing market.