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Epidemiologic trends in pulmonary mold infections were assessed. Of 227 infections, 24 were considered late-onset (>14 days) and Aspergillus less common (58.3% vs 78.3%; P = .030). For late-onset cases, Aspergillus was dramatically less frequent from 2020–2025 compared to 2014–2019 (11.1% vs 86.7%, P < .001), while Fusarium spp. increased (44.4% vs 0%, P = .012).
We propose a high-dimensional extension of the heteroscedasticity test proposed in Newey and Powell (1987). Our test is based on expectile regression in the proportional asymptotic regime where $n/p \to \delta \in (0,1]$. The asymptotic analysis of the test statistic uses the approximate message passing algorithm, from which we obtain the limiting distribution of the test and establish its asymptotic power. The numerical performance of the test is validated through an extensive simulation study. As real-data applications, we present the analysis based on “international economic growth” data (Belloni et al., 2013), which is found to be homoscedastic, and “supermarket” data (Lan et al., 2016), which is found to be heteroscedastic.
Mark Noll famously began his 1994 book, “The scandal of the evangelical mind is that there is not much of an evangelical mind.” Through the narrative of author Rachel Held Evans’s life, this article explores the intellectual state of the evangelical tradition during her lifetime, 1981–2019. Evans, a prolific author, blogger, and social media voice, was raised in conservative evangelicalism in Birmingham, Alabama, and Dayton, Tennessee. Her intellectual journey and abundant reading led her to challenge conservative evangelical views of gender and sexuality, creation, and hell, while holding to historic Christian beliefs. After experiencing rejection in-person and online from conservatives, especially Reformed Protestants associated with New Calvinism, she eventually renounced her beloved faith tradition of origin, evangelicalism. I argue that Evans’s faith trajectory illuminates the intellectual weaknesses of evangelicalism that Noll identified in 1994 and suggests that these weaknesses did not ameliorate in the first two decades of the twenty-first century. The intellectual state of evangelicalism, and its attendant political dimensions, was a key factor in Evans’s reluctant separation from evangelicalism, as it was for many of her contemporaries.
The school environment plays a key role in adolescents’ emotional development and well-being, yet little research has compared self-harm and related psychosocial problems across different secondary school types.
Methods:
Using data from the Growing Up in Ireland (GUI) longitudinal cohort, this study examined differences in the prevalence of self-harm and psychosocial risk factors across different school types: single-sex versus coeducational, fee-paying versus non-fee-paying, disadvantaged versus non-disadvantaged, and schools with different religious ethos. Multilevel regression models distinguished school-level from individual-level effects.
Results:
Almost all variance in self-harm and most of the variance in psychosocial problems associated with self-harm occurred at the individual level. Higher self-harm prevalence in single-sex girls’ schools was accounted for by the greater concentration of girls, who had over twice the odds of self-harm compared with boys (OR 2.1, 95% CI 1.71–2.69). No significant differences in self-harm were found by school socio-economic status or religious ethos. Disadvantaged schools showed higher prevalence in seven of nine psychosocial problems, although only internalising problems and truancy/absenteeism remained significantly associated with disadvantaged schools in the fully adjusted models. Adolescents whose parents reported having a religion were less likely to self-harm (OR 0.62, 95% CI 0.50–0.75).
Discussion:
Although schools are important settings for self-harm prevention, findings indicate that interventions should primarily target individuals and high-risk groups. Girls, in particular, may benefit from supports addressing self-harm. Disadvantaged schools, where well-established psychosocial risk factors for self-harm are more common, may benefit from well-being programmes targeting internalising problems and truancy/absenteeism.
Emotion regulation relies on the interplay between prefrontal and limbic brain regions, with prefrontal regions implicated in the top-down modulation of the amygdala. In social anxiety disorder, disruptions in these networks have been reported, but most studies used undirected functional connectivity.
Aims
Dynamic causal modelling (DCM) was used to assess effective (i.e. directed) connectivity differences during emotion processing and regulation in individuals with social anxiety disorder compared with healthy controls.
Method
A total of 102 participants (61 with social anxiety disorder, 41 healthy controls) performed a functional magnetic resonance imaging emotion regulation task under two conditions: viewing neutral/negative faces, and downregulating emotions using a self-chosen strategy. DCM was applied to model effective connectivity among the amygdala and key prefrontal regions. Connectivity patterns were characterised in healthy controls, and group comparisons tested how social anxiety disorder differed from this baseline model using parametric empirical Bayes. Leave-one-out cross-validation (LOOCV) evaluated whether connectivity differences predicted diagnostic group, symptom severity and emotion regulation difficulties.
Results
In healthy controls, observation of negative faces was characterised by reciprocal influences between the amygdala and prefrontal cortex (PFC), including increased amygdala-to-ventromedial PFC (vmPFC) connectivity and inhibitory vmPFC-to-amygdala connectivity. During emotion regulation, healthy controls showed negative modulation from the amygdala to all prefrontal regions. Patients with social anxiety disorder did not differ from controls in amygdala–prefrontal connectivity; their alterations were confined to prefrontal circuits, with inhibitory connectivity from the pre-supplementary motor area (preSMA) to dorsolateral PFC during observation and bidirectional excitatory connectivity between the preSMA and vmPFC during regulation. LOOCV indicated that connectivity differences predicted diagnostic group.
Conclusions
The results support the idea that emotion processing and regulation influence connectivity between prefrontal areas and the amygdala in a complex, feedback-driven manner. Our findings suggest that aberrant emotion regulation in social anxiety disorder appears to be more closely linked to differences in intra-prefrontal circuits than deficits in amygdala–prefrontal connectivity.
Legal and ethical frameworks remain dominated by a broadly binary conception of moral status as the primary organising idea: entities are typically treated either as persons, with extensive rights, or as things, with at best limited protections. While many jurisdictions now recognise animal welfare and anti-cruelty duties, these measures generally stop short of acknowledging independent full moral status. This landscape is ill-suited to the diversity of entities whose capacities challenge existing categories, from nonhuman animals to unprecedented beings. This article proposes a pragmatic spectrum of moral status, conceptualised as a continuous gradient on which entities can be located according to their morally relevant capacities. Grounded in a triangulation of established ethical theories, the framework is structured by three anchor thresholds—sentience, consciousness, and sapience—allowing graduated protections to “kick in” at different points. The spectrum is applied using a multimodal approach to measurement, demonstrating how it can guide governance where current law leaves a vacuum. By moving beyond the person/thing distinction with a capacity-based continuum, this approach offers a flexible, anticipatory tool for recognising and responding to the moral claims of diverse entities while avoiding both overreach and neglect.
Book 2 of Aristotle’s De anima is transmitted in two versions: a vulgate version, attested in the overwhelming majority of extant manuscripts, and a non-standard version, hitherto known primarily by the few subsisting remains of the original recension of manuscript Parisinus graecus 1853, the oldest extant direct witness. After identifying additional witnesses to the non-standard version, the article argues that it derives from the vulgate version and that some of its innovations originate in the ancient commentaries to the treatise.
We study projection algorithms for finding fixed points of nonexpansive mappings in a Hilbert space. In previous work, the well-definedness of the iterates depended on the nonemptiness of the fixed point set. We first show that the existence of the iterates generated by a general projection algorithm is independent of the existence of fixed points. Next, we introduce a multi-step inertial projection algorithm and establish results on existence, strong convergence and iteration complexity. Our results generalise and improve projection algorithms discussed in the literature.
With 70 million dead, World War II remains the most devastating conflict in history. Among the survivors, millions were displaced, returned maimed from the battlefield, or endured years of captivity. We examine the effects of such war exposures on labor market careers, showing that they often become apparent only at certain life stages. While war injuries reduced employment in old age, former prisoners of war prolonged their time in the workforce before retiring. Many displaced workers, especially women, never returned to employment. These responses align with standard life-cycle theory and thus likely hold relevance for other conflicts.
River deltas play a crucial role in the global carbon cycle, acting both as significant carbon sinks and as sources of CO₂ to the atmosphere. The Rhône River delta is a key site for studying these processes due to its high sedimentation rates and its unique radiocarbon signatures influenced by anthropogenic activities. This study compiles over 10 years of research to assess the sources and fate of organic matter (OM) in the Rhône River delta, using stable (δ13C) and radiogenic (Δ14C) carbon isotopes. New data from the MissRhoDia II campaign (2018) are compared with previous datasets (CarboRhone 2012; DICASE 2014) to analyze the interactions between terrestrial, riverine, and marine OM sources. The study examines sedimentary processes along a transect from the river mouth to the continental shelf, considering both sediment burial and porewater analyses. Results indicate that OM mineralized in proximal sediments is primarily of terrestrial origin, freshly supplied by the river, and potentially influenced by nuclear-related activity. In contrast, on the continental shelf, remineralization occurs at a slower rate due to the limited availability of organic substrate and isotopic signatures reveal a predominantly marine origin with a minimal anthropogenic influence. In the Rhône pro-delta sediments, the burial of radiocarbon-free organic carbon (aOC) underscores the role of sediment transport in long-term carbon storage, with contributions from both petrogenic and aged terrestrial organic carbon sources. The mineralization of young, labile carbon and the burial of more refractory carbon create significant differences between the 14C signatures measured in porewaters and sediments, highlighting the need to analyze both compartments. This study improves our understanding of carbon dynamics in the Rhône delta and provides valuable perspectives to better understand coastal carbon budgets, carbon sources, as well as the anthropogenic influence on marine ecosystems.
Early identification of patients with carbapenemase-producing Enterobacterales (CPE) colonization is crucial for infection control; however, microbiological testing may delay detection and be costly. Machine learning may enhance predictive analytics for timely identification of at-risk patients.
Methods:
Four machine learning models: Decision Tree, Random Forest, Gradient Boosting, and XGBoost, were used to predict CPE colonization within 48 hours of admission using microbiological and demographic data. Model performance was assessed through sensitivity, specificity, and area under the receiver operating characteristic curve (AUROC). Uniform Manifold Approximation and Projection (UMAP) evaluated topological separability of CPE-positive cases and CPE-negative controls.
Results:
From January 1, 2015 to December 31, 2024, 453,372 fecal specimens were submitted for CPE screening, with 194,917 (43.0%) collected within 48 hours of admission, comprising 3,328 CPE-positive cases (1.7%) and 191,589 CPE-negative controls. The Gradient Boosting classifier showed the best performance, achieving an AUROC of 0.598, sensitivity of 54.4%, and specificity of 59.1%. Demographic factors (age ≥ 75 and male sex), history of hospitalization, and known CPE colonization in the past year, and admission specialty (general medicine and general surgery) were consistently included in all models as top predictors. UMAP revealed significant overlap between CPE-positive and CPE-negative patients, indicating challenges in differentiating the risk profiles.
Conclusions:
This study highlights the complexities of using machine learning to predict CPE colonization within 48 hours of admission. The low AUROC values suggest that the models may not effectively predict CPE colonization at the patient level, potentially due to inherent rarity of events and overlapping risk profiles.
The potential of obesity medications to serve as viable alternatives to bariatric surgery to treat obesity remains an open question. This review examines whether contemporary anti-obesity pharmacotherapy can replace metabolic and bariatric surgery in the management of obesity, by critically comparing their mechanisms of action, weight loss outcomes, durability, safety profiles, and roles in long-term disease control. While metabolic/bariatric surgery has been the gold standard for substantial and sustained weight loss, advancements in pharmacotherapy are producing weight loss approaching surgical outcomes without associated risks, complications, and recovery time. New drug therapies demonstrate previously unattainable efficacy and long-term control of obesity. Surgery, however, induces superior short- and long-term weight loss via profound hormonal, neurological, and metabolic shifts, resulting in durable outcomes without ongoing intervention, though it remains difficult to scale. Pharmacotherapy is scalable and increasingly effective but requires sustained adherence, with loss of treatment-mediated control and weight regain upon cessation. It also does not have as extensive established research on safety as surgery. While obesity medications cannot fully replicate the multifactorial physiological impacts of metabolic/bariatric surgery, they offer a scalable, less invasive treatment path that broadens patient options. So far, pharmacotherapy will not replace surgery, as there are patients who will respond better to it, while others to medication only. However, combining both surgical and pharmacological options can increase the penetrance of treatments to manage the chronic complexities of obesity.
The ethically reflective assessment of life reveals a paradox. On the one hand, many people regard life as one of the highest values and celebrate each new life. On the other hand, every sentient life is inevitably exposed to suffering. Why, then, do we usually consider sentient life worth starting, despite the fact that, apart from a relatively small group of antinatalists, this judgment is rarely questioned? In this article, I argue that sentience is not an advantage but a disadvantage because its central negative consequence is unavoidable suffering for every sentient being. I further argue that bioethics and healthcare ethics should take antinatalist intuitions more seriously in order to challenge pronatalist assumptions that normalize procreation and, in doing so, magnify eradicable suffering.