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Electroconvulsive therapy (ECT) is an effective treatment of severe manifestations of mental illness. Since delay in initiation of ECT can have detrimental effects, prediction of the need for ECT could improve outcomes via more timely treatment initiation. Therefore, this study aimed to predict the need for ECT following admission to a psychiatric hospital.
Methods:
This study was based on electronic health record (EHR) data from routine clinical practice. Adult patients admitted to a hospital within the Psychiatric Services of the Central Denmark Region between January 2013 and November 2021 were included in the study. The outcome was initiation of ECT >7 days (to not include patients admitted for planned ECT) and ≤67 days after admission. The data was randomly split into an 85% training set and a 15% test set. On the 7th day of the inpatient stay, machine learning models (extreme gradient boosting (XGBoost)) were trained to predict initiation of ECT and subsequently tested on the test set.
Results:
The cohort consisted of 41,610 patients with 164,961 admissions. In the held out test set, the trained model predicted ECT initiation with an area under the receiver operating characteristic curve of 0.94, 47% sensitivity, 98% specificity, positive predictive value (PPV) of 24% and negative predictive value (NPV) of 99%. The top predictors were the highest suicide assessment score and mean Brøset violence checklist score in the preceding three months.
Conclusions:
EHR data from routine clinical practice may be used to predict need for ECT. This may lead to more timely treatment initiation.
Social cognitive impairments are a fundamental aspect of schizophrenia, exerting a substantial influence on patients’ functional outcomes. However, to date, there have been no meta-analyses of comprehensive pharmacological interventions covering all domains of social cognition. The aim of the present study was to address this knowledge gap by conducting a network meta-analysis, a comprehensive approach that systematically compares the efficacy of pharmacological interventions across all domains of social cognition.
Methods
A literature search for randomized controlled trials (RCTs) was conducted using PubMed, Embase, the Cochrane Central Register of Controlled Trials, PsycINFO, ClinicalTrials.gov, and the International Clinical Trials Registry Platform. The Preferred Reporting Items for Systematic Reviews and Meta-Analysis guidelines were followed.
Results
A total of 8,752 records were screened, and 60 RCTs involving 4,270 subjects were included in the systematic review. Thirty-six pharmacological interventions were extracted, but no compounds had a significant ameliorative effect on social cognition in comparison with placebo. In each domain of social cognition, the following compounds were identified as the most probable candidates for treatment selection: selective glycine uptake inhibitor (standardized mean difference [SMD], 0.46; 95% credible interval [CI], −0.52 to 1.44) and stimulant (SMD, 0.44; 95% CI, −0.57 to 1.45) for emotion perception in comparison with placebo. In the context of emotion processing, γ-aminobutyric acid (A) α2/α3 partial agonist (SMD, 0.33; 95% CI, −0.53 to 1.19) emerged as the top compound.
Conclusions
To date, no pharmacological interventions have demonstrated efficacy for social cognitive impairments in schizophrenia.
Dr. Mark Rupp served as Medical Director of the Infection Prevention Department at Nebraska Medicine for 28 years and as Chief of the Division of Infectious Diseases for 14 years before assuming his current role as Interim Chair of the Department of Internal Medicine at the University of Nebraska Medical Center (UNMC) in 2025. He is a Past President of the Society for Healthcare Epidemiology of America (SHEA; 2009) and delivered the SHEA Lecture at IDWeek 2020.
Dr. Rupp has authored more than 200 peer-reviewed articles, 48 book chapters, three textbooks, and holds three U.S. patents. He is an internationally recognized expert in clinical infectious diseases and healthcare epidemiology and is a frequent national and international speaker, educator, and media contributor.
Authoritarian regimes have increasingly leveraged foreign media to project influence within democracies, yet evidence of these co-opted outlets’ actual effects remains scarce. This study presents findings from a field experiment conducted during Taiwan’s 2020 general election, assessing the impact of The China Times, a Beijing-backed media conglomerate, on voter behavior and attitudes. The experiment incentivized participants to engage in sustained consumption of real-time news from this outlet in the weeks leading up to the election. Results from a panel survey linked to individual-level web-tracking data reveal that exposure to The China Times sways voters in favor of the People’s Republic of China (PRC). These effects, however, are primarily driven by nonpartisan and PRC-friendly voters. To the extent that I find effects among PRC-skeptics, they show evidence of backfiring. As Beijing’s media co-optation extends beyond Taiwan, my findings have broader implications for understanding the effectiveness and limitations of authoritarian influence operations.
Ischaemic heart disease (IHD) is a global health issue, with people of Indian origin facing earlier onset and more severe cases, leading to higher mortality at younger ages compared to Western countries. Indian migrants maintain similar risks post-migration. Managing modifiable risk factors and improving risk knowledge and health-seeking behaviours are essential, but research on IHD risk perceptions among Indian migrants is limited.
Aim:
This study explores how first-generation Indian migrants perceive their IHD risk and the factors influencing these perceptions.
Methods:
As a component of a mixed- method study, a qualitative descriptive study design was employed to examine study participants perception of their IHD risk and the influencing factors. Semi-structured interviews were conducted with Indian migrants residing in metropolitan Melbourne, Victoria using multiple Indian languages and English. Data were analysed in the original language, with findings reported in English. NVivo software was used for data management and analysis. A qualitative content analysis was conducted using a hybrid coding approach where the main categories were developed deductively and subcategories were developed inductively from the data.
Results:
Twenty interviews were conducted with participants aged 32 to 70, 55% of whom were female, with an average stay in Australia of 11.2 years. The main themes included: perceptions shaped by personal experiences, especially family history, with most underestimating their risk; migration, cultural norms, and time constraints hindering behaviour change; family support, religious beliefs, and longevity aspirations motivating healthier behaviours; and limited primary healthcare engagement and culturally appropriate health resources. These results are discussed within the context of Capability, Opportunity and Motivation model of behaviour change (COM-B).
Conclusion:
The study highlights key factors influencing IHD risk perceptions among Indian migrants. By understanding these specific risk perceptions and cultural nuances, healthcare professionals can develop and implement more effective, culturally sensitive health promotion and disease prevention strategies. This tailored approach can lead to better patient outcomes and a more equitable healthcare system.
The aim of this review was to identify, review, and synthesize primary qualitative literature to answer the question “what are the roles and experiences of informal caregivers providing care to a person with non-malignant respiratory disease at end of life from the perspectives of the caregiver and recipient of care?”
Methods
This qualitative systematic review was undertaken using thematic synthesis. Electronic databases (British Nursing Database, Cumulative Index to Nursing and Allied Health Literature Plus, Medline, PsycInfo, ProQuest Sociology, Allied and Complementary Medicine Database [AMED]) covering nursing, medicine, and social sciences were systematically searched from inception to October 2024. Studies were included if they reported data on the experiences and roles of caregivers in non-malignant respiratory disease at end of life, from the perspective of the caregiver or the person with non-malignant respiratory disease. Twenty-two papers met the eligibility criteria and were included in the review. Quality assessment was undertaken using the JBI Critical Appraisal Checklist for Qualitative Research.
Results
Thematic synthesis of the data generated five analytical themes: Caregivers experience shifting identity and new roles; Adaptation is necessary to cope with loss and change; Caregivers need more information and coordinated care services; Emotional effects of caregiving; and Future uncertainty and facing death. The findings illustrated the complexity of the caregiving role and highlight unmet needs during the end of life stage.
Significance of results
This evidence synthesis highlights the significant contribution caregivers make in the lives and deaths of those with non-malignant respiratory disease. Challenges of caregiving in this context increase the stress of caregivers, including unpredictable disease progression and difficult symptoms such as breathlessness. There are persistent inequalities between malignant and non-malignant care pathways. Caregivers would welcome more recognition and information from healthcare professionals to support their role.
The influence of one of a bilingual’s languages on the other is known as cross-linguistic influence (CLI). In grammatical gender acquisition, CLI can occur during gender discovery, assignment and agreement. The present study investigates CLI in Dutch as a heritage language, a language with a non-transparent gender system, in two groups of bilingual children. One (i.e., Dutch-German bilingual children) is acquiring languages with similar gender systems and the other (i.e., Dutch-French bilingual children) is acquiring languages with more distant gender systems. We found CLI in gender discovery, gender assignment and gender agreement for the Dutch-German group but not for the Dutch-French group. Moreover, CLI simultaneously facilitated and hindered gender acquisition within the children, depending on the gender congruency of the nouns. This suggests co-activation of grammatical gender values in bilingual children. The findings help us better understand when cross-linguistic influence takes place and how it affects acquisition in bilingual children.
Dilute Temperley–Lieb algebras are variants of Temperley–Lieb algebras arising in statistical mechanics in the study of solvable lattice models. In this article, we prove that the (co)homology of dilute Temperley–Lieb algebras vanishes in all positive degrees.
Though critic Paul Scudo predicted in 1850 that the French romance would be ‘more respected by posterity than many weighty scores’, the once-ubiquitous song genre has all but disappeared from modern recitals and musicological histories. While the reasons for this erasure are undoubtedly multifaceted, I argue that the loss of the vocal performance practices that animated the genre played a significant role. Specifically, French singers in the domestic sphere – commonly labelled ‘romance singers’ and exemplified by figures like the tenor Richelmi – cultivated an entirely different vocal production than the one popularzied by Gilbert Duprez and typically heard in classical singing today. This technique, known as the timbre clair (clear timbre), was produced using a rising larynx and a lowering soft palate, resulting in a bright, thin, delicate, and even slightly nasal sound that became a hallmark of early and mid-nineteenth-century French singing. Moreover, composers and audiences expected singers to adopt a declamatory approach when performing romances, to constantly vary the colour of their voices for expressive effect. By so doing, performers imbued these seemingly simple songs with a sophistication and nuanced meaning not readily apparent in the scores themselves. This study of timbral aesthetics – which, I suggest, ought to be more seriously explored in modern performance contexts – undercuts conceptions of the genre as vacuous or meaningless and sheds light on an essential aspect of the nineteenth-century French sound world.
To date, there has been a long-term debate between the monetarists and Keynesian schools on the elements of inflation in countries, whether monetary or fiscal. Over the years, with the advent of the political economics and the governments’ active participations to the economic and social activities, a new factor, among others, in the name of good governance – say, controlling the corruption level – has arisen as the decider of inflation in countries. This study aims to examine empirically whether money supply, government expenditure (both capital and revenue) and corruption do maintain any long-run associations and short-run dynamics with inflation for the panel of the world’s 20 leading countries. The results reveal a long-run association between the fiscal, monetary, and governance variables, and inflation; and in the short run, there are causal influences from total government expenditure, money supply and corruption to inflation in developed countries, but capital and revenue expenditures, money supply and corruption cause inflation in developing countries.
The ethics of the international monetary system (IMS) can be framed either as a case of background injustice or of structural injustice. Both ideas suggest that due to the background conditions, the interaction of agents, in a context of no rules, can lead to domination and unfairness. Moreover, both ideas emphasise the need to create regulation, or a structure, that prevents domination and unfairness. This article asks how (if at all) do monetary regimes, or each of the three scenarios that stem from the Mundell-Fleming trilemma, raise domination and unfairness. This article identifies domination and unfairness in both regimes with open capital markets: the one with floating exchange rates and the one with fixed exchange rates. Moreover, it offers a principle of non-domination, according to which institutions of the IMS ought to guarantee effective sovereignty of participant states or offer an equal distribution of this value when securing full effective sovereignty for all is not possible. For the last regime, of closed capital markets, this article identifies unfairness but no domination. By identifying domination and unfairness in each regime, this article proposes policies and regulation, or a structure, to prevent and mitigate these issues.
Mental health literacy (MHL) strategies are crucial for mental health promotion and prevention. This study aimed to determine the acceptability, feasibility, appropriateness and initial efficacy of an adapted MHL program in a community sample of adults in Kenya. This was a quasi-experimental pre-post study conducted from July 2023 through July 2024. The MHL program contained nine modules delivered over 3 days. Participants were assessed at baseline and immediately after the program. The primary outcomes were mental health knowledge and participants’ attitudes on mental health/illness. Secondary outcomes included depressive symptoms, anxiety symptoms, self-perceived social support, self-perceived wellbeing, MHL program acceptability, feasibility and appropriateness. Relative to baseline, we observed statistically significant improvement in mental health knowledge and attitude on mental health/illness postintervention. We also observed significant improvements in all secondary outcomes. The MHL program also emerged as contextually appropriate, acceptable and feasible. The adapted MHL program is acceptable and appropriate and can feasibly be delivered by trained non-specialist facilitators. Also, the MHL program has the potential to increase participants’ MHL and attitudes and reduce symptoms of common mental disorders and promote self-perceived wellbeing. Future research should explore how improvements can be sustained over the long term.
Linnaean taxonomy, which imposes hierarchical classifications based on morphological characteristics, has become deeply embedded in modern data architecture, from databases to metadata schemas to AI training datasets. With its hierarchical structure and rigid categorization, Linnaean taxonomy privileges one type of knowledge while marginalizing alternative taxonomies that offer more fluid, contextual, and relational understandings of the natural world. This paper examines how the legacy of Linnaean taxonomy continues to shape contemporary classification systems and artificial intelligence (AI). Indigenous knowledge systems, which include spiritual, cultural, and ecological dimensions, view entities not as isolated objects but as nodes in dynamic, interconnected networks. We draw from the French naturalist, Comte de Buffon, who, in line with Indigenous knowledge systems, viewed nature as continuous and contextual rather than discretely compartmentalized. The dominance of Linnaean-style classification in AI and data systems perpetuates colonial power dynamics and contributes to knowledge homogenization while losing Indigenous languages and classification systems crucial for addressing contemporary environmental challenges, particularly in agriculture and biodiversity conservation. In this Age of AI, we call for a holistic and ecological approach to archives. Therefore, we propose applying ‘rhizomatic hylomorphism,’ an ethnobiological, alternative classification that transcends hierarchical taxonomies to embrace multiplicity, relationality, and contextual meaning.
As in other European countries, mental healthcare in Belgium has to deal with the increasing cultural diversity that exists within society. However, commitment of the Belgian healthcare system toward cultural diversity remains weak, and clear guidelines on culturally competent psychiatric practice are still lacking.
Methods
Three focus groups with professional caregivers, three with adult patients, and one with young adults in the transition age were organized. The seven focus groups each consisted of 5–10 participants. Two brainstorming sessions with a total of 15 experts were organized a priori to delineate focus group topics. Data analysis software MAXQDA 24 was used for thematic analysis.
Results
The thematic tree consists of the central theme “culturally sensitive mental healthcare” with five main themes (i.e., vulnerable population, language barrier, mental healthcare stigma, spirituality/religion, Western vs non-Western frame of reference). These themes are further stratified into a number of subthemes and one overarching theme (i.e., diversity policy). The themes have resulted in six recommendations to improve cultural psychiatric care. These recommendations underscore the vulnerability of the target patient population, specific training needs, the need for professional interpreters and intercultural mediators, the place of religion and spirituality in therapy, reflexivity as core competence, and the need to establish reference centers.
Conclusions
The six recommendations provide a scientifically sound base to develop focused and effective mental health policies at the governmental, organizational, and patient level. Continued attention to the importance of cultural sensitivity in mental healthcare provision remains important, particularly in countries that are lagging behind.
Traced monoidal categories model processes that can feed their outputs back to their own inputs, abstracting iteration. The category of finite-dimensional Hilbert spaces with the direct sum tensor is not traced. But surprisingly, in 2014, Bartha showed that the monoidal subcategory of isometries is traced. The same holds for coisometries, unitary maps, and contractions. This suggests the possibility of feeding outputs of quantum processes back to their own inputs, analogous to iteration. In this paper, we show that Bartha’s result is not specifically tied to Hilbert spaces, but works in any dagger additive category with Moore–Penrose pseudoinverses (a natural dagger-categorical generalization of inverses).
This article examines the institutional evolution and professionalization of the state police in Prague during the final decades of the Habsburg monarchy, arguing that the transformation of the Prague State Police between 1893 and 1910 represents a proactive effort in modern state-building. Drawing on reports from the Prague Police Directorate and the Bohemian Governor’s Office, it analyzes how recurring episodes of mass violence—specifically the unrest of the early 1890s, the riots of December 1897, and the nationalist disturbances of 1908—exposed the structural vulnerabilities of a security apparatus designed for routine policing rather than mass politics.
The article highlights a significant shift in administrative strategy: the movement away from a reliance on military intervention, which was increasingly viewed by civil authorities as a “double defeat” that undermined the legitimacy of the constitutional state. Instead, police directors such as Georg Dörfl and Karel Křikava successfully advocated for a robust, civilian-controlled force characterized by increased manpower, modernized equipment, and the establishment of a dedicated reserve for professional training. By 1910, the Prague Guard had largely expanded, reflecting a fundamental reconceptualization of urban order where protest was accepted as an unavoidable feature of political life to be contained by professional civilian forces rather than crushed by the army.
Excess prescribing of antibiotics and opioids is a major public health concern. A greater understanding of prescribing patterns at the prescriber and beneficiary level could inform enhanced and integrated interventions.
Methods:
Using 2023 Medicare Part D Public Use data, we conducted a cross-sectional study to assess opioid and antibiotic prescribing patterns among primary care clinicians (internal medicine, family medicine, geriatrics, nurse practitioners, and physician assistants) in New York State (NYS) treating ≥20 Medicare beneficiaries aged ≥65. For each provider, the total days’ supply of antibiotics and opioids per beneficiary was calculated. Multivariate logistic regression models identified provider and practice characteristics associated with high-prescribing.
Results:
Of the 19,823 eligible prescribers, 647 (3.3%) were high antibiotic prescribers and 554 (2.8%) were high opioid prescribers. Antibiotic high-prescribing was associated with nurse practitioners (NP) (adjusted odds ratio (aOR 2.47, 95% CI 1.83–3.34)), physician assistants (PA) (aOR 1.90, 95% CI 1.43–2.54), more years in practice (aOR 1.62 per SD, 95% CI 1.47–1.78), and panels with higher average beneficiary risk scores (aOR 1.36 per SD, 95% CI 1.29–1.43). Opioid high-prescribing was associated with geriatrics (aOR 4.30, 95% CI 1.79–10.32), NP (aOR 1.80, 95% CI 1.36–2.37), male gender (aOR 1.55, 95% CI 1.17–2.04).), greater years in practice (aOR 1.68, 95% CI 1.51–1.86), and higher proportions of dual-eligible beneficiaries (aOR 1.38, 95% CI 1.23–1.56).
Conclusions:
A small number of NYS clinicians account for a disproportionate share of antibiotic and opioid prescribing. Identifying provider- and panel-level characteristics associated with higher prescribing may inform targeted stewardship strategies.
Training for knowledge and attitude change can be a key component of improving animal care and welfare. Much of the available research is focused upon the livestock industry but can be applied to other animal industries. In the research and teaching industry (RTI), training is an important legal, regulatory, professional, and ethical responsibility as well as a forming part of the social licence for industry. A comparative study was developed to explore the impact of training targeting attitudes and knowledge on participants’ use of grimace scales (GS) in the Australian and New Zealand (ANZ) RTI. Participants were recruited into training sessions that excluded (control) or included (enhanced) training targeting attitudes. Prior to any training, cohorts received a mixed-methods, quantitative-qualitative questionnaire to determine baseline knowledge and attitudes towards GS, animal welfare, and pain management. Post-training, participants completed questionnaires to investigate changes in their knowledge or attitudes. Training (control and enhanced) resulted in up to eight times more positive attitudes and knowledge towards the GS and pain management. Only enhanced training for attitudes offered additional key benefits with participants being up to three times more confident in GS and more likely to offer pain relief. The results from this study demonstrate the ability for GS training to improve human-animal interactions with potential improvements in pain management, animal welfare, the 3Rs, and research. These outcomes support the greater body of literature and best practice recommendations for RTIs to require and implement training programmes that incorporate attitudinal training in animal care and use programmes.