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Diagnostic classification models assume the existence of latent attribute profiles, the possession of which increases the probability of responding correctly to questions requiring the corresponding attributes. Through the use of longitudinally administered exams, the degree to which students are acquiring core attributes over time can be assessed. While past approaches to longitudinal diagnostic classification modeling perform inference on the overall probability of acquiring particular attributes, there is particular interest in the relationship between student progression and student covariates such as intervention effects. To address this need, we propose an integrated Bayesian model for student progression in a longitudinal diagnostic classification modeling framework. Using Pòlya-gamma augmentation with two logistic link functions, we achieve computationally efficient posterior estimation with a conditionally Gibbs sampling procedure. We show that this approach achieves accurate parameter recovery when evaluated using simulated data. We also demonstrate the method on a real-world educational testing data set.
Cable-driven exoskeletons have recently shown great promise in the rehabilitation of stroke survivors. Numerical modeling/simulation provides a cost- and time-effective approach to fine-tuning design parameters of the exoskeletons, hence reducing the need for expensive and time-consuming experimental trials. This study investigated using a cable-driven lower limb rehabilitation exoskeleton (C-LREX) to correct stroke-impaired gait and track reference healthy trajectories. The impact of different levels of impairment and subject anthropometry variation on the model’s performance was studied. The C-LREX model was successful in assisting the impaired limb to track the reference trajectory in all impaired gait patterns, except for higher impairment levels (>20° range of motion deviation at the hip joint). Subject anthropometry variation did not affect trajectory tracking when the cable routing was scaled to fit the user’s anthropometry. This study confirmed that the C-LREX model could simulate various impaired lower limb gait patterns in the sagittal plane and determine the cable tension requirements needed to correct the impairment. Future work includes expanding the framework to incorporate frontal plane motion and to validate C-LREX performance in assisting biplanar impaired motion.
There are critical gaps within implementation science concerning health equity, particularly for minoritised ethnic groups. Implementation framework adaptations are important to facilitate health equity, which is especially relevant for psychiatry due to ethnic inequities in mental health; however, the range of potential adaptations has yet to be synthesised.
Aims
This systematic scoping review aimed to identify and map the characteristics of adaptations to implementation frameworks for minority ethnic groups to improve health equity.
Method
Bibliographic searches of the MEDLINE, Embase, PsycINFO and CINAHL databases were conducted, spanning the period from 2004 to February 2024 for descriptions of implementation frameworks adapted for minority ethnic groups. The characteristics of those meeting the criteria were narratively synthesised.
Results
Of the 2947 papers screened, six met the eligibility criteria. Three different types of implementation frameworks were adapted across the six papers: evaluation, process and determinant frameworks. Most of the adaptations were made by expanding the original framework, and by integrating it with another model, theory or framework with an equity focus. The adaptations primarily focused on putting equity at the forefront of all stages of implementation from intervention selection to implementation sustainability. No studies measured the effectiveness of the adapted framework.
Conclusions
The findings demonstrate that implementation frameworks are modifiable, and different elements can be adapted according to the implementation framework type. This review provides a starting point for how researchers and healthcare providers can adapt existing implementation frameworks to promote health equity for minoritised groups across a range of healthcare settings.
Childhood trauma is a well-established risk factor for psychosis, paranoia, and substance use, with cannabis being a modifiable environmental factor that exacerbates these vulnerabilities. This study examines the interplay between childhood trauma, cannabis use, and paranoia using standard tetrahydrocannabinol (THC) units as a comprehensive measure of cannabis exposure.
Methods
Data were derived from the Cannabis&Me study, an observational, cross-sectional, online survey of 4,736 participants. Childhood trauma was assessed using a modified Childhood Trauma Screen Questionnaire, while paranoia was measured via the Green Paranoid Thoughts Scale. Cannabis use was quantified using weekly standard THC units. Structural equation modeling (SEM) was employed to evaluate direct and indirect pathways between trauma, cannabis use, and paranoia.
Results
Childhood trauma was strongly associated with paranoia, particularly emotional, and physical abuse (β = 16.10, q < 0.001; β = 16.40, q < 0.001). Cannabis use significantly predicted paranoia (β = 0.009, q < 0.001). Interactions emerged between standard THC units and both emotional abuse (β = 0.011, q < 0.001) and household discord (β = 0.011, q < 0.001). SEM revealed a small but significant indirect effect of trauma on paranoia via cannabis use (β = 0.004, p = 0.017).
Conclusions
These findings highlight childhood trauma as a primary driver of paranoia, with cannabis use amplifying its effects. While trauma had a strong direct impact, cannabis played a significant mediating role. Integrating standard THC units into psychiatric research and clinical assessments may enhance risk detection and refine intervention strategies, particularly for childhood trauma-exposed individuals.
This article presents a critical postcolonial analysis of international human rights law’s engagement with human trafficking through the lens of seven UN treaty bodies. Drawing on content analysis of 1,197 documents (33 General Comments/Recommendations, 1,049 Concluding Observations, and 115 Individual Communications), the article reveals how international human rights law is implicated in the status subordination of subaltern people. The article identifies 54 documents containing evidence of colonial legacies, with 76% of relevant Concluding Observations addressing Global South states. It argues that treaty bodies reinscribe colonial patterns through problematic conflation of trafficking with slavery, promotion of repressive migration policies, inconsistent treatment of prostitution and sex tourism, perpetuation of ‘raid and rescue’ approaches, and essentialization of trafficking victims as ‘innocent’. It also exposes limited engagement with intersectionality in individual communications, potentially overlooking complex, multifaceted experiences of trafficking victims. The article concludes by proposing concrete strategies to decolonise anti-trafficking law and practice, including interrogating assumed neutrality in legal instruments, embracing a politics of recognition, integrating the concept of ‘burdened agency’, and meaningfully countenancing intersectionality in legal analyses. This analysis contributes to understanding how international human rights law can better serve its emancipatory potential while avoiding the perpetuation of status subordination.
Deep brain stimulation (DBS) is being investigated as a treatment for patients with refractory major depressive disorder (MDD). However, little is known about how DBS exerts its antidepressive effects. Here, we investigated whether ventral anterior limb of the internal capsule stimulation modulates a limbic network centered around the amygdala in patients with treatment-resistant MDD.
Methods
Nine patients underwent resting state functional magnetic resonance scans before DBS surgery and after 1 year of treatment. In addition, they were scanned twice within 2 weeks during the subsequent double-blind cross-over phase with active and sham treatment. Twelve matched controls underwent scans at the same time intervals to account for test–retest effects. The imaging data were investigated with functional connectivity (FC) analysis and dynamic causal modelling.
Results
Results showed that 1 year of DBS treatment was associated with increased FC of the left amygdala with precentral cortex and left insula, along with decreased bilateral connectivity between nucleus accumbens and ventromedial prefrontal cortex. No changes in FC were observed during the cross-over phase. Effective connectivity analyses using dynamic causal models revealed widespread amygdala-centric changes between presurgery and 1 year follow-up, while the cross-over phase was associated with insula-centric changes between active and sham stimulation.
Conclusions
These results suggest that ventral anterior limb of the internal capsule DBS results in complex rebalancing of the limbic network involved in emotion, reward, and interoceptive processing.
Weeds significantly reduce sugarcane (Saccharum officinarum L.) production by 30% to 50% and cause complete crop loss in severe cases. Guangxi, a central sugarcane-growing region in southern China, faces significant challenges due to the proliferation of weeds severely impacting crop tillering, yield, and quality. In this study, we surveyed and identified 35 weed species belonging to 16 families in Longzhou, Nongqin, and Qufeng, with significant threats posed by purple nutsedge (Cyperus rotundus L.), bermudagrass [Cynodon dactylon (L.) Pers.], hairy crabgrass [Digitaria sanguinalis (L.) Scop.], black nightshade (Solanum nigrum L.), white-edge morningglory [Ipomoea nil (L.) Roth], and ivy woodrose [Merremia hederacea (Burm. f.) Hallier f.]. The application of 81% MCPA-ametryn-diuron achieved greater than 90% control within 15 d. Although herbicides are effective, they can unintentionally harm sugarcane, indicating a need for tolerant genotypes. Therefore, we comprehensively evaluated herbicide-induced phytotoxic responses and identified tolerant sugarcane genotypes over 3 yr of trials conducted on 222 genotypes across Guangxi. We quantified phytotoxicity by counting the number and severity of affected leaves. The ANOVA revealed statistically significant main and interaction effects among genotype, crop cycle, and location. Cluster and discriminant analyses classified the genotypes into five groups: 21 highly tolerant (HT), 68 tolerant, 75 moderately tolerant, 18 susceptible, and 40 highly susceptible. The 21 HT genotypes demonstrated strong potential to be used as parental lines for breeding herbicide-tolerant varieties, to inform precision breeding strategies, and to increase tolerance to herbicide stress in sugarcane.
Using bi-contact geometry, we define a new type of Dehn surgery on an Anosov flow with orientable weak invariant foliations. The Anosovity of the new flow is strictly connected to contact geometry and the Reeb dynamics of the defining bi-contact structure. This approach gives new insights into the properties of the flows produced by Goodman surgery and clarifies under which conditions Goodman’s construction yields an Anosov flow. Our main application gives a necessary and sufficient condition to generate a contact Anosov flow by Foulon–Hasselblatt Legendrian surgery on a geodesic flow. In particular, we show that this is possible if and only if the surgery is performed along a simple closed geodesic. As a corollary, we have that any positive skewed $\mathbb {R}$-covered Anosov flow obtained by a single surgery on a closed orbit of a geodesic flow is orbit equivalent to a positive contact Anosov flow.
Teamwork relies on collaboration to achieve goals that exceed individual capabilities, with team cognition playing a key role by integrating individual expertise and shared understanding. Identifying the causes of inefficiencies or poor team performance is critical for implementing targeted interventions and fostering the development of team cognition. This study proposes a teamwork cognitive diagnostic modeling framework comprising 12 specific models—collectively referred to as Team-CDMs—which are designed to capture the interdependence among team members through emergent team cognitions by jointly modeling individual cognitive attributes and a team-level construct, termed teamwork quality, which reflects the social dimension of collaboration. The models can be used to identify strengths and weaknesses in team cognition and determine whether poor performance arises from cognitive deficiencies or social issues. Two simulation studies were conducted to assess the psychometric properties of the models under diverse conditions, followed by a teamwork reasoning task to demonstrate their application. The results showed that Team-CDMs achieve robust parameter estimation, effectively diagnose individual attributes, and assess teamwork quality while pinpointing the causes of poor performance. These findings underscore the utility of Team-CDMs in understanding, diagnosing, and improving team cognition, offering a foundation for future research and practical applications in teamwork-based assessments.
Many observational studies often involve multiple levels of treatment assignment. In particular, fuzzy regression discontinuity (RD) designs have sequential treatment assignment processes: first based on eligibility criteria, and second, on (non-)compliance rules. In such fuzzy RD designs, researchers typically use either an intent-to-treat approach or an instrumental variable-type approach, and each is subject to both overlapping and unique biases. This article proposes a new evidence factors (EFs) framework for fuzzy RD designs with sequential treatment assignments, which may be influenced by different levels of decision-makers. Each of the proposed EFs aims to test the same causal null hypothesis while potentially being subject to different types of biases. Our proposed framework utilizes the local RD randomization and randomization-based inference. We evaluate the effectiveness of our proposed framework through simulation studies and two real datasets on pre-kindergarten programs and testing accommodations.
Rome’s mid-republican period is back in the centre of attention. Roman money and coinage, however, are largely absent from the debate. As this field has seen important developments in recent years, this paper surveys recent research in order to explore how numismatic sources can contribute to our understanding of this formative period in Roman history. First, we present an overview of these new developments, which we then contextualise in the framework of the Roman economy, Roman state formation and the development of a distinct Roman identity. We argue for a development from coinage irregularly commissioned by individual Roman magistrates to a regular Roman state coinage; from haphazard production often outside Rome to large-scale and more regular coordinated production clearly institutionalised within the Roman state, with a distinct Roman appearance. We propose to recognise two principal moments of acceleration in this process: around 240 and, above all, 210 b.c.e., and show how these insights relate to broader debates on mid-republican Rome.
The “demographic dividend” refers to the boost to GDP per capita growth countries experience during the part of the demographic transition when age dependency ratios plummet. The size and the source of the dividend are debated in the literature. Using newly constructed age-specific population data by country from the beginning of the demographic transition to the present day, this paper estimates the contribution of changing age structure to GDP per capita growth during the demographic transition. A quantitative overlapping-generations model is used to produce country-specific estimates of the dividend and to disentangle its drivers. Model simulations for 101 countries suggest a global average boost of 0.40 percentage points per annum to GDP per capita growth during the dividend period. Changing age structure explains 9.5% of total growth during the period of the demographic dividend on average. Countries with more rapid and more extreme changes in age structure experience larger dividends.
The three books under review converge around state fragility, security concerns, and governance deficits as their organizing theme. This theme, which can be deployed to describe the current cadence of politics in several sub-Saharan African countries, proceeds from the nature of African states and the dynamics of political power as exemplified in the cases of Ghana and Nigeria in the three books. The first, edited by Usman Tar and Bashir Bala is a twelve-chapter anthology on rural violence in Nigeria. The second, which is edited by David Ehrhardt, David Alao, and Sani Umar, is also composed of twelve chapters and explores traditional authority and security in contemporary Nigeria. The first two works illuminate the dimensions of ecoviolence, including farmer-herder violence, banditry, terror, and other forms of conflicts in Nigeria. The third book by Barry Driscoll is focused on Ghana and concentrates on power relations in the decentralized local state. Ghana is a stable state with a subtle but deep-running powerful clientelist network that weaves its operations around party politics.
Informed by an international dialogue on sustainable financing for noncommunicable diseases and mental health in 2024, this Editorial explores some of the key financing issues to be addressed in September 2025 at the United Nations General Assembly high-level meeting on noncommunicable diseases and mental health, including those relating to domestic resource mobilisation, external assistance and health financing reforms.
Hypothalamic hamartomas (HHs) are a known cause of refractory focal epilepsy. Advancement in microsurgical techniques and introduction of stereotactic ablative methods have led to improved complication rates, but the effect on seizure control is still to be determined. In this systematic review, we present a thorough analysis of published literature on the outcomes of various surgical treatments of HHs for refractory epilepsy.
Methods:
A literature search using the MedLine, SCOPUS and Cochrane databases was conducted. All English language studies describing surgical treatment of HH with refractory epilepsy, with a minimum of three patients and a follow-up of at least one year, were identified.
Results:
An initial selection of 55 studies was reduced to 41 after combining studies from the same groups; 14 open, 4 endoscopic, 8 Gamma Knife radiosurgery (GKRS), 9 laser interstitial thermal therapy (LITT) and 6 radiofrequency thermocoagulation (RF-TC) studies were included. From a total of 832 patients, 209 underwent open (25.1%), 80 endoscopic (9.6%), 124 GKRS (14.9%), 229 LITT (27.5%) and 190 RF-TC (22.8%). Engel I or ILAE 1 or 2 was achieved in: open 115 (55.0%), endoscopic 38 (47.5%), GKRS 49 (39.5%), LITT 176 (76.9%) and RF-TC 128 (67.4%). Invasive surgeries (open and endoscopic) had a higher incidence of neurological complications (27.0%) than ablative surgeries (GKRS, LITT, RF-TC) (7.2%). Reoperation rates were higher for ablative surgeries (23.8%) than invasive surgeries (9.0%).
Conclusion:
Surgical treatment of HH causing refractory epilepsy is effective. RF-TC and LITT surgery types have the highest Engel class I outcomes, and ablative surgeries have a lower neurological complication profile compared to open and endoscopic approaches.
Lightning strike is rare, with a reported incidence of around 1:100,000. There are few reports of survival after cardiac arrest due to lightning strike. We report the case of a 12-year-old male survivor. Though he had a prolonged out of hospital cardiac arrest and initial poor systolic function, widespread ST segment elevation on electrocardiography, and elevated cardiac troponin I, he survived with a good cardiac and neurological outcome.