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Genetic predisposition to obesity can stimulate an increase in adiposity throughout adulthood. However, the interaction between genetic factors and dietary habits may modify the genetic association with obesity. Thus, this study aimed to investigate the dietary patterns that influence the genetic risk of obesity in a Korean population using a large cohort study and genome-wide association study.
Design:
Prospective cohort study.
Setting:
The genetic risk score (GRS) was calculated based on six identified SNP of the OTOL1, NMBR, DNAJB9, ASCC1, NT5C2 and FTO genes associated with obesity, as ascertained by BMI. Dietary patterns were determined using food intake data from an FFQ and factor analysis.
Participants:
This study included data from 8458 adults aged 40–69 years from the Ansan and Ansung cohorts of the Korean Genome and Epidemiology Study.
Results:
The refined carbohydrate dietary pattern showed a significant inverse association with obesity in the highest GRS group with a non-significant interactive association (OR: 0·801; 95 % CI: 0·662, 0·969; P for trend = 0·0251, P for interaction = 0·571). However, participants with the highest refined carbohydrate dietary pattern score and highest GRS had an increased prevalence of obesity (OR: 1·288; 95 % CI: 1·068, 1·554; P for trend = 0·0251) compared with the prevalence of those with the lowest dietary pattern score and GRS.
Conclusions:
Reducing refined carbohydrate consumption may be helpful for Korean adults with a greater genetic susceptibility to obesity.
This article proposes and studies two Huber-type estimation approaches, namely, the Huber instrumental variable (IV) estimation and the Huber generalized method of moments (GMM) estimation, for a spatial autoregressive model. We establish the consistency, asymptotic distributions, finite sample breakdown points, and influence functions of these estimators. Simulation studies show that compared to the corresponding traditional estimators (the two-stage least squares estimator, the best IV estimator, and the GMM estimator), our estimators are more robust when the unknown disturbances are long-tailed, and our estimators only lose a little efficiency when the disturbances are short-tailed. Moreover, the Huber GMM estimator also outperforms several robust estimators in the literature. Finally, we apply our estimation method to investigate the impact of the urban heat island effect on housing prices. A package is published on GitHub for practitioners to use in their empirical studies.
This paper uses China’s 2016 Pollutant Discharge Permits System (PDPS) to evaluate its impact on innovation in the food processing industry. We begin by exploring the entry and exit decisions of food processing firms. The findings suggest that stricter environmental enforcement following the PDPS leads to decreased local firm entry but increased neighboring firm entry, indicating that new firms tend to locate in neighboring regions with less stringent regulations. Building upon this pattern, we argue that the PDPS’s positive impact on firm innovation is primarily driven by increased industry agglomeration – a dynamic directly stimulated by heterogeneous regulatory pressures.
The clock drawing test is widely used in clinical neurological and neuropsychological assessment. We hypothesized that younger adults would have greater problems with clock drawing than older adults, perhaps due to decreasing analog clock use.
Methods:
Cross-sectional study analyzing clock drawing performance and cognitive function across four generations (Gen Z, Millennials, Gen X, Baby Boomers). Participants included 92 adults divided into two generations (63 younger [18–42 years old] and 29 older [43–77 years old]) assessed between October 2022 and December 2024. Participants were screened to exclude conditions affecting cognition. The primary outcome was performance errors in clock drawing (e.g., writing “11:10” instead of drawing an analog clock, or placing hands incorrectly), assessed using standardized criteria. Cognitive function was assessed using eight computerized tests (CogState) measuring processing speed, attention, executive function, visuospatial memory, and verbal memory. Confirmatory factor analysis (CFA) validated three cognitive domain composites: Speed/Attention, Executive/Spatial, and Verbal Memory.
Results:
Performance errors were significantly more prevalent among younger participants compared with older participants (p = .016; risk ratio, 4.45). The effect size was large (Cohen’s h = .63). The generation effect was stronger (OR = 28.66, p = .003) after controlling for CFA-validated cognitive domain composites. This provides strong evidence that generational differences are independent of cognitive abilities.
Conclusions:
Younger adults demonstrate significantly higher rates of clock drawing errors compared with older adults, independent of cognitive performance. These findings suggest a need for generation-specific or age adjusted norms in clock drawing test interpretation.
To identify key factors associated with varying levels of Medicare’s Chronic Care Management (CCM) programme implementation in rural primary care practices in the United States.
Background:
Despite demonstrated benefits for both patients and providers, CCM implementation remains low nationwide. While previous studies have examined payment-related challenges, limited research exists on other implementation factors such as leadership engagement, organizational culture, and provider training, particularly in rural settings.
Methods:
This mixed-methods study examined CCM implementation across six rural primary care practices in Wyoming. Thirteen healthcare professionals participated in semi-structured interviews guided by the Consolidated Framework for Implementation Research (CFIR). Practice performance data collected over three consecutive months were used to categorize sites as high or low implementers based on care coordinator productivity, percentage of care coordinated, and programme sustainability. Interview transcripts were analysed using CFIR constructs to identify factors that distinguished high from low-implementing sites, with each factor rated based on its impact (positive, negative, or neutral) and strength of influence.
Findings:
Three CFIR constructs strongly distinguished between high and low implementation sites: networks and communication, leadership engagement, and reflecting and evaluating. High-implementing sites demonstrated effective team communication, supportive leadership, and regular programme evaluation practices. In contrast, low-performing sites faced poor communication, minimal leadership support, and weak feedback mechanisms. Further research is needed to examine the effectiveness of targeted interventions designed to strengthen these organizational factors in rural primary care settings, particularly focusing on developing scalable strategies that account for resource limitations and geographic isolation.
In a ruling delivered on 1 August 2025, the Court of Justice upheld a General Court judgment annulling the classification as a suspected carcinogen of titanium dioxide in powder form containing at least 1% of particles of a diameter equal to or below 10 μm. Both EU Courts criticise the scientific assessment underlying that classification, but the Court of Justice relies on conceptual distinctions that reveal its reluctance to perform a genuine “manifest error of assessment” review. While these issues are not addressed by the Court of Justice, the case also raises thorny questions regarding the meaning of “intrinsic properties” of a substance.
To compare neurological and functional outcomes after ultra-early microdiscectomy (≤12 h) versus later surgery (12–24 h, 24–48 h, >48 h) in adults with acute lumbar disc herniation presenting with motor weakness and/or cauda equina syndrome.
Methods:
We retrospectively studied 300 consecutive adults undergoing emergency microdiscectomy (2015–2025) at a tertiary center. Patients were grouped by time from presentation to surgery (≤12 h, 12–24 h, 24–48 h, >48 h). Primary outcomes were motor recovery (Medical Research Council scale) and pain improvement; secondary outcomes were complications, length of stay (LOS), recurrent emergency visits and recurrent herniation. Nonparametric tests and logistic regression were used with a prespecified significance level of p < 0.001.
Results:
Ultra-early surgery was associated with more rapid immediate motor gains, most notably in plantarflexion/dorsiflexion, and shorter LOS (≤12 h: 3.8 days; >48 h: 6.2 days). Over the ≤48 h window, long-term motor recovery did not differ among ≤12 h, 12–24 h and 24–48 h groups. Rates of complications, recurrent emergency visits and recurrent herniation did not vary by timing.
Conclusion:
In acute presentations with neurological deficits, microdiscectomy performed within 48 h remains the key threshold for favorable outcomes. Ultra-early surgery (≤12 h) appears to accelerate early neurological recovery and reduce LOS in selected acute cases, without evidence of superior long-term motor outcomes versus other ≤48 h windows. Prospective, symptom-stratified studies are warranted.
Social media often follow a visual logic found to increase engagement, as images are more likely to attract attention, presenting information on a holistic-associative basis. For a political entity like the EU, social media are a promising route to overcome the remoteness to its citizens, identified as one of the crucial challenges to its public legitimacy. Against this broader background, our study analyses the influence of 10 years of EU visual social media communication on user engagement as an indicator of successfully creating visibility in a crucial communication space. For this purpose, we conducted an image-type analysis, combining quantitative and qualitative features of visual analysis: First, a subsample of posts was inductively analysed to identify recurring image types and subsequently used to implement a manual quantitative visual content analysis. Building on the results, we drew on a machine learning approach, allowing us to analyse over 40,000 posts, including more than 20,000 pictures. Our results emphasise the crucial influence of social media affordances in explaining user engagement with EU visual social media communication. Implications are discussed with reference to the ongoing discussion about the EU’s democratic deficit.
In the 1970s, activists in the Youth International Party transformed new technologies and techniques in the American telephone system into tools for advancing the political aims of the New Left. The Yippies adopted new practices of telephone “hacking” or “phone phreaking” and developed these practices to manipulate, defraud, and protest the AT&T Bell System. Appeals to and protests of “the system” invoked the image of a broader American state. The practice of phone phreaking bridged the technical exploitation of AT&T with critiques of monopoly capitalism, state surveillance, postwar conformity, and American empire. By the late 1970s, as the New Left faded in prominence and the Bell System was itself broken up, the vernacular of system changed. Within an emerging “computer underground” of phreaks, hackers, and users connected through electronic bulletin board systems, the Yippie vernacular of system was reinterpreted as a critique of the state in the language of ascendant conservative and libertarian politics.
It is crucial to properly evaluate the traits that directly impact agricultural productivity. Some of these traits, such as soil erosion or crop diseases, are quantified with scoring systems. The resulting data are strictly ordinal and often have an underlying percentage scale. Deciding which model to use for this type of data is not straightforward. Ordinal scores do not meet the assumptions required for analysis of variance. Although multinomial ordinal models, particularly the threshold model, can be applied, they do not account for the underlying percentage scale of the data. To address this limitation, a hurdle model tailored for interval-censored percentage data is proposed. It is a two-part model that models the data according to their nature: In its first part, it models presence or absence of a disease (incidence), and in the second part it models severity or abundance. Individually modelling presence and absence in the first part allows to account for zero inflation. The second part implements theory from the threshold model and the Johnson SB system of distributions that involves a transformation of the percentage scale to a normal distribution. The model result also reflects the two components. They individually describe the degree of disease infestation, and the degree of disease spread. This improves interpretability and enables concrete, insightful conclusions. To illustrate the model, mildew scorings from an on-farm trial in grapevines were used. The model was found highly suitable for this dataset and superior to the threshold model.
Although stably stratified shear flows, where the base velocity shear is quasi-continuously forced externally, arise in many geophysically and environmentally relevant circumstances, the emergent dynamics of their ensuing statistically steady stratified turbulence is still an open question. We address this phenomenon in a series of three-dimensional direct numerical simulations using spectral element methods. We consider a forced, stably stratified shear flow with an initial bulk Reynolds number $\textit{Re}_{0} = 50$, an initial bulk Richardson number $\textit{Ri}_{0} = 1/80$ (also corresponding to the initial minimum gradient Richardson number $\textit{Ri}_{{g}}$) and a fluid of Prandtl number ${\textit{Pr}} = 1$ in horizontally extended domains. Although the initial configuration is unstable to a primary Kelvin–Helmholtz instability, the ensuing turbulence is sustained by continuously relaxing the resulting flow back towards the initial profiles of streamwise velocity and buoyancy. We study statistical as well as structural aspects of the final statistically steady flows, including the flux coefficient $\varGamma _{\chi }$ and dynamically emergent length scales $\varLambda$ associated with the large-scale dynamics, respectively. Despite the ongoing stirring and mixing, we find that the shear layer half-depth converges to a finite value of $d \approx 8$ (i.e. $\varLambda _{z} \approx 16$) once the horizontal extent of the domain $L_{{h}} \gtrsim 96$. While this implies a final ${{Re}} \approx 400$ and ${Ri} \approx 0.1$, we hypothesise that such forced flows ‘tune’ themselves eventually to a state of a gradient Richardson number $\textit{Ri}_{{g}} \lesssim 0.2$, consistently with several previous studies. Moreover, provided sufficiently extended domains, we observe the emergence of large-scale flow structures with spanwise $\varLambda _{\!y} \approx 50$ and streamwise $\varLambda _{x} \lesssim 115$. Clearly, these observations demonstrate the marked anisotropy of characteristic emergent length scales, even for such ‘weakly stratified’ forced shear flows. We conjecture that the actual emergent streamwise structures are a vestigial ‘imprint’ in the sheared turbulent flow of the primary linear instability of the converged deepened turbulent shear layer.
Relationships among teachers are known to influence their teaching-related perceptions. We study whether and how teachers’ advising relationships (networks) are related to their perceptions of satisfaction, students, and influence over educational policies, recorded as their responses to a questionnaire (item responses). We propose a novel joint model of network and item responses (JNIRM) with correlated latent variables to understand these co-varying ties. This methodology allows the analyst to test and interpret the dependence between a network and item responses. Using the JNIRM, we discover that teachers’ advising relationships contribute to their perceptions of satisfaction and students more often than their perceptions of influence over educational policies. In addition, we observe that the complementarity principle applies in certain schools, where teachers tend to seek advice from those who are different from them. The JNIRM has the potential to improve the cost efficiency of network studies by integrating network and item response information during model estimation.
Even though the incidence of conflicts between Fulani nomadic pastoralists and sedentary communities in Nigeria has risen significantly in the last decade, there is a notable lack of research examining how these conflicts influence distrust towards members of the Fulani ethnic group and Muslims. Using novel survey data from Kaduna, the state with the third-highest incidence of pastoral conflict in Nigeria, this study addresses that gap. Regression analyses show that exposure to pastoral conflict increases distrust towards the Fulani and Muslims. This suggests a contagion effect whereby the Fulani are conflated with the broader Muslim population, due to the Muslim identity of nomadic Fulani pastoralists. Disaggregating the data by religious affiliation reveals a pattern: conflict exposure raises distrust only among Muslim respondents, while effects are statistically insignificant among Christians. Among Muslims, the positive effect suggests that pastoral conflict erodes in-group cohesion. The null effect among Christians may reflect the way in which pastoral conflicts align with pre-existing religious fault lines.
Despite improvement over the past few decades, particularly for white, cisgender women, intersectional gender-based inequality remains prominent within anthropological archaeology and beyond. Building on critiques of the leaky pipeline metaphor laid out in the introduction to this themed issue, and drawing on Black, Indigenous, and Posthumanist Feminisms, we advocate for a metaphorical shift focused on care, inclusivity, and diversity—that of a garden. The garden metaphor provides a way to express and explore the complex and intertwined ways disciplinary norms, institutions, and individuals structure and shape experiences in archaeology. After reviewing the garden metaphor and summarizing previous suggestions for improving equity in archaeology, we present recommendations for actionable steps at disciplinary, institutional, supervisory, and individual levels. Drawing on insights from the articles in the issue, as well as existing literature within and beyond archaeology, we argue that a greater emphasis on care, and its integration into the value structure of archaeology, would create a more inclusive discipline.
The McMurdo Dry Valleys in the Ross Sea Region of Antarctica represent a globally unique desert ecosystem where water availability is likely to change under global warming scenarios, thus influencing the distribution and abundance of biota. Using the Random Forest machine learning model, we focused on the spatial distribution of macroscopic terrestrial biota (moss, cyanobacteria, lichen, springtails and mites) in the Dry Valleys. A wetness index, explicitly driven by satellite-derived glacier surface temperatures and meltwater routing, was used along with biological survey data collected over six field seasons (2009–2014) as part of the New Zealand Terrestrial Biocomplexity Survey (n = 886 sites). Our analyses use the full extent of survey data available and include the larger Taylor, Wright and Victoria valleys, as well as data from the previously studied Miers, Marshall and Garwood valleys. The overall model accuracies were mixed (kappa statistic: 0.34% and 17.3% variance explained). However, the resulting predictive maps derived from the model and the influence of the different explanatory variables align with field observations and theoretical expectations. The models show that distance from coast was an important driver for the biota, as well as elevation and temperature. The predictive maps provide an initial model of the distribution of biota in the Dry Valleys and can guide future sampling as well as inform conservation and management strategies. Our research highlights the importance of biological survey data for use in spatial predictive modelling as well as the need to obtain representative samples from a wide range of different habitats (e.g. wet vs dry).
How do states use drone exports to build their leverage with buyers? The scholarly literature acknowledges that states use arms exports to cement alliances, improve the capacities of allies and support their domestic arms industry. But there has been no examination of how suppliers of unmanned aerial vehicles (UAVs) tailor their export strategies to develop leverage with their buyers. This paper deploys SIPRI’s classification of arms exporters (hegemonic, industrial, and restrictive) and describes how each uses a varying combination of inducements (bundling, lock-ins, and predatory pricing) and risk-mitigation strategies to build leverage while avoiding reputational damage from being drawn into external conflicts. Examining new data on seven types of follow-on sales or defence cooperation agreements after drone sales, this paper finds that of the three of the five major drone suppliers – China, Turkey, and to a lesser extent Iran – operate like hegemonic exporters. To test the proposed mechanisms, it explores how China and Turkey have exploited their drone exports to build leverage with Pakistan. It offers conclusions about how drone diplomacy will evolve as the export market diversifies.
Previous estimations of the associations between fruits and vegetables (F/V) intake with diabetes markers showed mixed results, possibly partly because of the subjective assessment of dietary intake. We aimed to examine the relationship between plasma carotenoids and α-tocopherol (as objective markers of F/V intake) and fasting glucose. This was a population-based cross-sectional study in 592 adults in Cameroon. Self-reported F/V intake was assessed using the WHO STEPS questionnaire, and the biomarkers were analysed by HPLC. The mean age of participants was 38·5 (sd 8·6) years (63·7 % women). The median (IQR) number of times participants self-reported consuming fruits in a typical week was 2(1–5) and vegetables was 4(2–7) times/week. Plasma total carotenoids was positively correlated with self-reported intake of fruits (r = 0·13) and vegetables (r = 0·29), both P-values < 0·01. In unadjusted analysis, the difference in fasting glucose comparing the highest against the lowest tertile of the biomarkers concentrations was −0·28 (95 % CI −0·56, −0·001) mmol/l for total carotenoids and −0·31 (–0·59, −0·03) mmol/l for plasma α-carotene. The associations became stronger after adjusting for sociodemographics, lifesyle factors and cholesterol (–0·36 (–0·73, −0·002) mmol/l for total carotenoids and −0·41 (–0·79, −0·03) mmol/l for α-carotene). There was no evidence of an association between α-tocopherol and fasting glucose. We showed an inverse association of total carotenoids and α-carotene, objective indicators of F/V intake, with fasting glucose; suggesting that higher F/V intake may be beneficial for diabetes prevention in African populations where F/V intake is low.
In this study, we investigate the dynamic behaviour of reconfigurable circular plates under acceleration as a model problem to understand the interplay between kinematics and shape deformation in biological propulsion. A high-resolution force transducer and time-resolved particle image velocimetry were employed to simultaneously capture both hydrodynamic forces and vortex dynamics. The results reveal that, unlike rigid plates that exhibit Reynolds number independence, the force evolution of reconfigurable plates is governed by the dimensionless bending stiffness ${\textit{EI}}^*$. A distinct load-shifting phenomenon is observed – characterized by a reduction in peak force amplitude and an elevation of the postpeak force trough, contrasting with the ‘peak-valley’ behaviour typical of rigid plates. Based on ${\textit{EI}}^*$, reconfigurable plates are classified into three regimes: extra-flexible (${\textit{EI}}^* \lt 2.28 \times 10^{-3}$), flexible ($2.28 \times 10^{-3} \leqslant {\textit{EI}}^* \leqslant 0.143$) and rigid (${\textit{EI}}^* \gt 0.143$). Notably, only plates within the flexible regime exhibit the load-shifting phenomenon. Flow visualizations show that the flexible plates, due to their shape reconfiguration, produce flow fields with two distinct features: initially, the formation of three-dimensional, non-axisymmetric vortex rings; subsequently, vortex breakdown occurs due to instability. By applying the vorticity moment theorem, force generation is accurately estimated from the flow field. Using a vortex-based low-order force model, the radial distribution of vorticity is identified as the key mechanism underlying the load-shifting phenomenon. This finding suggests that biological morphing structures in real propulsion scenarios can reduce force fluctuations without compromising average thrust by ‘load-shifting’, offering insights into efficient propulsion strategies.