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Microwaves (MWs) have emerged as a promising sensing technology to complement optical methods for monitoring floating plastic litter. This study uses machine learning (ML) to identify optimal MW frequencies for detecting floating macroplastics (>5 cm) across S, C, and X-bands. Data were obtained from dedicated wideband backscattering radio measurements conducted in a controlled indoor scenario that mimics deep-sea conditions. The paper presents new strategies to directly analyze the frequency domain signals using ML algorithms, instead of generating an image from those signals and analyzing the image. We propose two ML workflows, one unsupervised, to characterize the difference in feature importance across the measured MW spectrum, and the other supervised, based on multilayer perceptron, to study the detection accuracy in unseen data. For the tested conditions, the backscatter response of the plastic litter is optimal at X-band frequencies, achieving accuracies up to 90% and 80% for lower and higher water wave heights, respectively. Multiclass classification is also investigated to distinguish between different types of plastic targets. ML results are interpreted in terms of the physical phenomena obtained through numerical analysis, and quantified through an energy-based metric.
Metabolic imprinting refers to lasting metabolic changes from early-life environmental exposures, especially nutritional, that impact adult health and chronic disease risk. We investigated whether metabolic imprinting by small litter size (SL) activates interscapular brown adipose tissue (iBAT) and affects glucose and lipid metabolism, oxidative damage, and insulin resistance (IR) in young rats exposed to a high-sucrose diet (HSD) over eight weeks. Male Wistar rats (n = 48) were assigned to control (eight pups/ dam; CL) and small litter (four pups/ dam; SL) groups. Post-weaning (21 days), they were divided into four dietary groups: (i) standard diet (STD, chow diet) from CL, or (ii) SL; (iii) HSD (30% sucrose) from CL, or (iv) SL, for eight weeks. Afterward, animals were euthanized for analysis of iBAT and serum samples. HSD caused hypertrophy, IR, and oxidative damage in iBAT. However, the SL model attenuated HSD-induced IR by up-regulating p-AKT (Ser 473) and activating iBAT thermogenesis, resulting in decreased PGC1-α expression and up-regulating UCP1 expression, which contributed to iBAT hyperplasia. Additionally, SL reduced PKA activation and free fatty acid (FFA) release, decreasing the lipid oxidative damage observed in HSD-fed iBAT. These findings suggest that SL-induced metabolic imprinting enhances iBAT thermogenesis through p-AKT (Ser 473) and PGC1-α signaling, increases UCP1 expression, and reduces PKA substrates phosphorylation, decreasing FFA levels and oxidative damage following HSD exposure. While our results challenge the existing literature, we propose that the metabolic plasticity from the SL model allows rats to adapt to dietary variations and may protect against HSD-induced IR in adulthood.
The Nova classification(1) categorises foods according to the degree of food processing. Ultra-processed food have undergone a high level of industrial processing and typically contain cosmetic additives(1). Increased consumption of ultra-processed food has been associated with adverse health outcomes, including obesity and chronic diseases(2). Evaluating household food acquisition according to the Nova classification allows the assessment of dietary quality within populations, a strategy of nutrition surveillance that can support the development of effective public health actions to improve dietary quality. In Aotearoa New Zealand (NZ), there is limited up-to-date information on population dietary habits and a lack of data on ultra-processed food consumption. This study aimed to: i) develop a methodology to classify food items purchased by NZ households according to the Nova food groups: unprocessed/minimally processed foods (Group 1 [G1]), processed culinary ingredients (Group 2 [G2]), processed foods (Group 3 [G3]), and ultra-processed foods (Group 4 [G4]) and; ii) to describe the proportions of unique food items purchased according to Nova. We obtained data on food items purchased by NZ households from the 2019 NielsenIQ Homescan® panel, a national dataset of approximately 2,000 households who recorded their grocery purchases over 1-year. In total, 28,824 unique items were purchased. Using barcodes, we merged the products with the 2019 Nutritrack dataset, an inventory of NZ supermarkets foods(2), to obtain the products’ ingredient lists. We followed best practices for classification according to Nova(3). Where available, the ingredient lists were used to classify products. Of the total unique products, 13,263 (46%) were matched to Nutritrack and classified based on their ingredient lists. For the remaining 15,561 products (54%), we identified whole Nielsen product categories (PC) that were exclusively associated with a single Nova group. Items classified by PC level included rice, fresh fruits, eggs and coffee beans in G1; baking powder, liquid cooking oils and salt in G2; beer and wine in G3; and margarine, carbonated soft drinks and bubble gum in G4. An additional 6,398 products were identified at this stage, representing 41.1% of the total 15,561 products without ingredient lists. We classified the remaining 9,163 items (58.9% of those 15,561 without ingredient list) based on the distribution of Nova groups for the 60% most purchased items within their PC. If the ingredient list was absent for any item under the 60% most purchased group, it was obtained from a search of online supermarkets. The final unweighted distribution of unique products purchased in NZ according to the Nova classification were 5583 (21.7%) in G1, 671 (2.6%) in G2, 3043 (11.8%) in G3, and 16466 (63.9%) in G4. Further stages of the research will estimate the energy from Nova groups derived from household food purchases in NZ, examining socioeconomic distribution and temporal trends.
The “Critically Endangered” Cherry-throated Tanager Nemosia rourei is endemic to the Atlantic Forest of south-eastern Brazil, and extremely rare for reasons that are not yet fully understood. We monitored reproductive activities of the only known individuals of the species, at two sites, between October 2018 and November 2023. The birds foraged in social groups of 5–8 individuals. Ten nests, built in trees at heights of 12–26 m, were monitored through continuous direct observation. Most reproductive activity occurred between October and end of November, with one further nest found in March. Clutch size was 3–4 eggs, the incubation and nestling periods were 16 days, and the chicks were fed mainly on invertebrates. Up to six nest helpers, likely young from previous seasons, assisted with the collection of nest material, feeding the chicks, and defending the nest. Reproductive success was 50%, with losses due to climatic conditions (rain and cold) and predation, but may have been enhanced by the efforts of the researchers in scaring away potential predators including Spot-billed Toucanet Selenidera maculirostris and Black Capuchin Sapajus nigritus. These findings reinforce the value of detailed observation of social groups and their nests, and continuing efforts to deter predators. Further research could address how parental care and nest helpers affect reproductive success. The availability of large trees with abundant lichens may be a limiting factor for the reproductive success of species in the long term, and so protecting and restoring habitat with such features is crucial for the long-term conservation of this species.
Obstetric complications (OCs) are associated with cognitive and brain abnormalities observed in patients with schizophrenia. Gyrification, a measure of cortical integrity sensitive to events occurring during the prenatal and perinatal periods, is also altered in first-episode psychosis (FEP). We examined the relationship between OCs and gyrification in FEP, as well as whether gyrification mediates the relationship between OCs and cognition.
Methods
We examined differences in the Local Gyrification Index (LGI) for the frontal, parietal, temporal, occipital, and cingulate cortices between 139 FEP patients and 125 healthy controls (HCs). Regression analyses explored whether OCs and diagnosis interact to explain LGI variation. Parametric mediation analyses were conducted to assess the effect of LGI on the relationship between OCs and cognition for FEP and HC.
Results
Significant LGI differences were observed between FEP patients and HC in the left parietal and bilateral cingulate and occipital cortices. There was a significant interaction between OCs and diagnosis on the left cingulate cortex (LCC) that was specific to males (p = 0.04) and was driven by gestational rather than intrauterine OCs.
In HCs, OCs had a direct effect on working memory (WM) (p = 0.048) in the mediation analysis, whereas in FEP, we observed no significant effect of OCs on either verbal or WM.
Conclusions
OCs interact with diagnosis to predict LCC gyrification, such that males with FEP exposed to OCs exhibit the lowest LGI. OCs influence WM, and LCC gyrification may mediate this relation only in HC, suggesting a differential neurodevelopmental process in psychosis.
To investigate associations between dietary intake and patterns of food preparation by age group.
Design:
This cross-sectional study analysed dietary intake data from the most recent Portuguese National Food, Nutrition and Physical Activity Survey. Cluster analysis categorised dietary intake based on the source of food preparation. Regression models were used to study the association between dietary daily intake, Healthy Eating Score (HES) and patterns of food preparation.
Setting:
Portugal, using data representative of the Portuguese population.
Participants:
A total of 5005 Portuguese residents aged 3–84 years were included in the analysis. Dietary intake and food preparation patterns were examined by age group.
Results:
The predominant pattern of food preparation was food prepared by restaurants, canteens and other away-from-home establishments (45·9 %, 95 % CI = 43·8, 48·1). Children and adolescents in this pattern had significantly higher intakes of energy and carbohydrates but lower protein intake compared with those consuming predominantly home-prepared foods. Among adults and the elderly, this pattern was associated with higher intakes of energy, saturated fats, trans fats and free sugars and lower fibre intake. Additionally, children and adolescents whose diets predominantly included food prepared away-from-home showed a decrease in HES (β = –0·7, 95 % CI = –1·3, –0·2), and adults experienced a greater reduction (β = –1·2, 95 % CI = –1·5, –0·9).
Conclusions:
In Portugal, consuming food prepared away from home is associated with poorer dietary quality, with higher energy and unhealthy nutrient intake and lower HES, suggesting a need for interventions focused on promoting healthier food preparation practices.
The aim of the study was to evaluate calcium anacardate (CAn), associated or not with citric acid (CAc) in laying hen diets on performance, egg quality, serum biochemical profile, serum lipid peroxidation (TBARS) and catalase (CAT) in reproductive tissue. A total of 432 laying hens from 63 to 74 weeks of age, were distributed in nine diets: Control; 0.25% CAn; 0.25% of CAn associated with 0.25% CAc; 0.50% CAn; 0.50% CAn associated with 0.25% CAc; 0.50% CAn associated with 0.50% CAc; 0.75% of CAn; 0.75% CAn associated with 0.25% CAc; 0.75% CAn associated with 0.50% CAc. There was no effect of CAn or CAc on laying hen performance. Yolk colour showed greater pigmentation for 0.75% CAn and its associations with CAc (0.25% and 0.50%). Lower egg yolk oxidation was observed for an isolated dose of 0.75% CAn. Higher values of TBARs were observed in eggs from birds fed control diet; 0.25% CAn; 0.50% CAn associated with 25% CAc and 0.75% CAn associated with 0.25 and 0.50% CAc. Dietary inclusion of CAn (0.75%) and its association with CAc (0.50% CAn with 0.50 CAc) for late-phase laying hens reduce serum peroxidation. CAn from 0.50% associated with CAc increases catalase in magnum. The addition of 0.75% CAn increases yolk pigmentation, reduces lipid oxidation in the yolk and blood plasma and increases CAT activity in the magnum in late-stage laying hens. These benefits can also be obtained with the combination of 0.50% CAn and 0.50% CAc.
Kalicephalus (Molin, 1861) comprises 33 species of gastrointestinal snake and lizard parasites with a cosmopolitan distribution, with seven taxa occurring in the Neotropical realm. In the present study, we describe Kalicephalus atroxi n. sp., found parasitising the snake Bothrops atrox, from the Eastern Amazon in the State of Amapá, North of Brazil. We used an integrative approach that included light microscopy, scanning electron microscopy, and sequencing of the internal transcribed spacer 1 (ITS1) region to describe Kalicephalus atroxi n. sp. The new species has a buccal capsule characteristic of the genus, a slight cuticular inflation in the cephalic region. The females have an amphidelphic reproductive system, a vulva with prominent lips, and a long tail, tapering posteriorly. The males have long and alate spicules, and the copulatory bursa is lobed with dorsal rays with distinct morphology compared to their congeners. Molecular analyses and phylogenetic reconstructions cluster the new species into a well-supported clade with K. costatus costatus, from Chironius fuscus, from the same locality in northern Brazil. Kalicephalus atroxi n. sp. is the eighth species of the genus in the Neotropics, the seventh in Brazil, the second described parasitising B. atrox in Brazil, and the first species of snake nematode described in the State of Amapá.
Over the years, the number of parasitic helminth species discoveries has not ceased to increase and the popularisation of the use of molecular methods has contributed greatly to sustain the growth in knowledge. However, molecular approaches evolved rapidly in the last 20 years. I argue that the research community working on parasitic helminths has lagged behind in the application of molecular methods that examine multiple loci to study species diversity. In this paper, I review the recent historical trends in the molecular markers used to study trematode diversity. Except for the emergence of pioneer mitogenome studies, the use of markers has not changed in the past 10 years. It is still restricted to single locus or a combination of two, rarely three, mitochondrial and ribosomal loci. I identify past and current molecular approaches providing data on multiple loci across the genome which have found resistance in the trematode and the helminth parasitology fields over the last four decades. I discuss how the knowledge gained from the analysis of genome-wide markers would benefit research on parasite diversity today, in particular for cases of species complexes, cryptic (or nearly cryptic) species, recently diverged species, and species with a complex taxonomic history, or a history of suspected mitonuclear discordance as well as for taxa with wide geographical distributions or species with disjoint distributions. Furthermore, I argue that both, studies with classical markers and reduced-representation genome studies providing genome-wide markers should not walk different paths but feedback on each other to advance the field forward. I examine some challenges and make recommendations for obtaining high-throughput molecular data of parasitic helminths.
Understanding the interplay between adiposity and histopathological features of colorectal tumours is crucial for advancing strategies in disease management. We conducted a retrospective cohort study over an 8-year period (2007–2015), including patients who underwent surgical resection for colorectal cancer (CRC). Body composition was assessed via computed tomography (CT) at the level of the third lumbar vertebra, with visceral adipose tissue (VATd) and subcutaneous adipose tissue (SATd) radiodensities stratified into tertiles. Systemic inflammatory status was evaluated using the neutrophil-to-lymphocyte ratio (NLR). Logistic regression was employed to analyse the relationship between variables, using OR with 95 % CI. The Cox proportional hazards model assessed hazard ratios (HR) with 95 % CI. A total of 231 patients were included (48·9 % men, 51·1 % women), with 93·6 % in CRC stages II and III. Multivariate analyses demonstrated that CRC stages II and III (OR = 5·15, 95 % CI: 1·60, 16·62; OR = 5·16, 95 % CI: 1·59, 16·77) and low VATd (1st and 2nd tertiles; OR = 2·43, 95 % CI: 1·30, 4·53) were associated with the presence of desmoplasia. In the multivariate Cox analyses, only stage III disease (HR = 4·77, 95 % CI: 1·09, 20·89) and moderate to accentuated fibrous stroma (HR = 1·90, 95 % CI: 1·03, 3·46) were identified as predictors of reduced overall survival. These findings suggest that increased visceral adiposity may contribute to the development of a desmoplastic tumour microenvironment. Moreover, the presence of moderate to accentuated fibrous stroma is significantly associated with poorer long-term survival in patients with CRC.
Ochoterenella is a large group of filarial parasites of anurans distributed throughout Central and South America. In the present study, we describe a new species of Ochoterenella parasitizing 2 frogs, Boana geographica and Boana multifasciata, from different localities in the Brazilian Amazon. The main morphological traits that differ Ochoterenella casiraghii n. sp. from its congeners are the smaller body size, a shorter cephalic plate, smaller parastomal structures, and the small, short and rounded cuticular bosses on the body of both sexes. The females have a shorter ovejector, and the number of caudal papillae distinguishes males. Pairwise sequence comparisons of the new species reveal a high level of divergence from Ochoterenella spp. Our phylogenetic analyses, based on cox1 and concatenated partial mitochondrial genes, support the monophyly of all subfamilies and genera examined herein. The new species represents the 17th in the Ochoterenella genus and a new parasite record for both anuran species. We provide the first ultrastructural description of the species in the genus and establish the phylogenetic relationships of the new species among parasites of amphibians and reptiles from the Onchocercidae.
Aims: Main aim of this quality improvement project was to ensure that each outpatient CAMHS clinic room is equipped with the necessary, functional equipment for safe and comprehensive baseline and ongoing monitoring of patients prescribed antidepressant, antipsychotic, and ADHD medications, in line with NICE guidelines, the Maudsley Prescribing Guidelines and hospital guidelines.
Methods: The sites included in this project are Raglan house (single point of access), The Clock house (Community Service South Oxfordshire), Slade and Maple house (neurodevelopmental conditions outpatient service in Oxford).
Data collection was conducted with the help of a checklist to be used for each clinic room in outpatient CAMHS. All four sites were included in the data interpretation process each having 54 items in the checklist. It includes quantitative and qualitative data which are crucial to ensure standards and to meet requirements by the guidelines mentioned above. These items consist of three groups, physical health monitoring, infection prevention as well as privacy, confidentiality and comfort. Some of the items were window blinds and engaged/vacant for privacy and confidentiality; sanitiser and soap for infection prevention; stethoscope and height measurement tool for physical health.
Results: On average, 44% of checklist items were present on the sites, which means 56% items were not available. Of the present items, 96% were working well, whereas 4% were dysfunctional such as a clock with no battery, an unstable scale, a faulty thermometer and limited amount of sanitiser. Moreover, concerns were raised about shortage of rooms for routine and urgent appointments across multiple sites despite online and telephone appointments being offered. In addition, some of the rooms did not have appropriate lighting. The issues that pose immediate risk to patients’ safety were prioritised and reported to the estates. The rest is planned to be reported at the time this abstract was written.
Conclusion: Functional clinical equipment is essential to ensure patient safety. Efficient and active use of channels to report missing or dysfunctional items as well as regular maintenance and calibration of clinical items are key to excellent caring and safe care. All staff members are responsible to make sure that appropriate equipment is available.
Aims: Individuals with ADHD and autism may face increased risks of cardiovascular issues or metabolic disorders influenced by both their neurodevelopmental traits and prescribed treatments. Ensuring consistent monitoring can help manage these risks and support better long-term outcomes. This paper explores the challenges of physical health monitoring in ADHD and autism and presents a quality improvement project aimed at enhancing monitoring practices in clinical care.
Methods: Challenges in physical health monitoring for individuals with ADHD and autism include variability in practice, limited access to medical equipment, space constraints in clinical settings, and the need for clearer guidelines. To address these issues, we conducted an assessment within the ADHD and autism service in Oxfordshire to identify essential materials for comprehensive monitoring of ADHD medications, antipsychotics, and antidepressants, alongside overall physical well-being.
Results: Key materials identified included blood pressure monitors, ECG machines, height and weight measurement tools, blood glucose and cholesterol testing kits, liver and kidney function tests, electrolyte testing kits, drug screening tests, and nutritional assessment tools. The assessment identified several challenges in physical health monitoring within ADHD autism service. Out of 12 assessed items, 58.33% had the necessary materials available, though essential equipment was not always present, and time constraints made integration difficult. Among those, 85.7% had functioning equipment, while 14.3% had non-functional equipment.
Conclusion: In ADHD and autism services, where psychopharmacology plays a central role in treatment, the importance of physical health monitoring becomes even more critical due to the side effects of medications such as stimulants, antipsychotics, and antidepressants. Inconsistencies in equipment availability, maintenance, and staff training were noted, leading to potential risks to patient safety, reduced efficiency, and increased costs. Recommendations include improved maintenance, acquisition of additional equipment, and enhanced staff training to ensure effective monitoring across services.
Aims: Specialist mood disorder services in the UK are diverse in structure and spread over different clinical-academic centres in the UK. Relationships between these centres are strong but often based on academic projects, with limited opportunities for clinical case discussions. The NIHR Mental Health Translational Research Collaboration, together with the ASCEnD trial team, has set up an online monthly meeting of tertiary mood disorder services: the Mood Disorders Grand Rounds (MDGR). The aims are: 1) to bring together people with expertise and interest from different centres across the UK; 2) to discuss complex and difficult to treat (or interesting) cases; 3) to consider treatment options. The format includes a 20-minute anonymised case presentation by a specialist, covering clinical and thematic aspects, followed by a 40-minute panel discussion focusing on case management, related themes, and relevant research studies. The presentership rotates between centres around the country and encourages a multidisciplinary approach.
Following the first 12 months of MDGR, we distributed a survey to evaluate and develop the meetings.
Methods: An evaluation form was developed and sent to all registered attendees over the course of six months, on a rolling basis. Participants were asked to both rate the effectiveness of various aspects of the programme and to submit suggestions for improvement, including suggestions for future speakers. Questions included both Likert scored items and free text responses.
Results: We received 21 responses (12% of those registered). 75% of respondents had not been to a similar regular collaborative programme previously. 50% of respondents stated that the MDGR had directly influenced their clinical practice, examples being of “Using MAOIs in a case where I hadn’t considered it before” and “identification of a patient with likely autoimmune encephalitis”. The remaining 50% stated that whilst the programme was relevant it had not had a direct result on practice.
Conclusion: A high proportion of respondents reported their clinical practice had been directly influenced by attendance. This suggests the MDGR is fulfilling the stated aim of focusing on clinical discussions and is of value to attenders. The rate of response is low and could be biased to those who found it more useful.
In the last ten years, the recovery movement has significantly influenced mental health services and workers, psychiatric reform, and the advocacy movement worldwide. Within Brazil’s public mental health care system, operates a cohesive, powerful advocacy coalition empowering recovery-oriented practices. This article aims to highlight successful initiatives spearheaded by individuals with lived experience in Brazil. We will also present some challenges, and discuss possible recovery strategies to strengthen mental health services by empowering people with lived experience and promoting social justice. Efforts and initiatives to implement recovery strategies in Brazil are underway, aiming to improve population mental health and substance misuse both within and outside mental health services. These initiatives include peer support, advocacy, testimonies and empowerment, employment, and social, cultural, and artistic initiatives. Some of the challenges to greater participation of individuals with lived experience in this ongoing process of Brazilian psychiatric reform include the following aspects: barriers to the autonomy and independence of lived experience organizations; the longstanding history of racism in Brazilian society; disparities in social indicators such as education and income, between professionals and people with lived experience in mental health and substance misuse. Although progress in Brazil’s psychiatric reform has advanced through recovery initiatives, challenges remain in ensuring leadership roles for people with lived experience. Ongoing success depends on their active involvement, alongside advocacy movements and involvement of broader society.
Phase Angle (PhA) has emerged as an important parameter to monitor body composition, fluid status, muscle integrity, and physical performance among athletes. However, limited information exists regarding the associations between PhA and dietary intake, especially in athletes. This study aimed to identify the dietary intake components associated with PhA in athletes. This cross-sectional observational study was carried out with 153 athletes across 17 sports. Body composition was assessed by tetrapolar multifrequency BIA, and dietary intake by 24-hour dietary recalls administered on non-consecutive days. Reported foods and supplements were categorised into different groups (i.e. cereals, vegetables, fruits, beans and nuts, meat and eggs, dairy products, oils, and sugars), with portions established based on the food’s total energy content. Fat-free mass and fat-free mass index were higher in male compared to female athletes, potentially influencing PhA (6.6º vs 5.5º; P < 0.01). Multiple linear regression analysis indicated that protein intake was a significant predictor of PhA in athletes. This association remained significant even after adjustments for sex, age, and fat-free mass (R2 = 0.48, β = 0.27, P = 0.02). The positive correlation observed between dietary protein and PhA reinforces the need for adequate daily protein intake to enhance PhA in athletes. Further studies investigating the effect of diet-induced changes in PhA within the athletic population are necessary.
Recent changes to US research funding are having far-reaching consequences that imperil the integrity of science and the provision of care to vulnerable populations. Resisting these changes, the BJPsych Portfolio reaffirms its commitment to publishing mental science and advancing psychiatric knowledge that improves the mental health of one and all.
This study aimed to evaluate the effects of acetyl-L-carnitine on follicle survival and growth, stromal cell density and extracellular matrix, as well as on the expression of mRNA for nuclear factor erythroid 2-related factor (NRF2), superoxide dismutase (SOD), catalase (CAT), glutathione peroxidase (GPX) and peroxiredoxin 6 (PRDX6) in cultured bovine ovarian cortical tissues. Ovarian fragments (3 × 3 × 1 mm) were cultured for 6 days in α-MEM+ alone or supplemented with 10, 50 or 100 μM acetyl-L-carnitine at 38.5°C with 5% CO2 in humidified air. Before (non-cultured tissues) and after culture, the ovarian fragments were fixed in 4% paraformaldehyde for 12 h for histological analysis or stored at –80ºC for mRNA expression analysis of NRF2, SOD, CAT, PRDX6 and GPX1. The results showed that 100 μM acetyl-L-carnitine increased the percentages of morphologically normal follicles and stromal cell density in cultured ovarian tissues. On the other hand, acetyl-L-carnitine did not influence the percentage of collagen in ovarian tissue nor the expression of mRNAs for NRF2, SOD, CAT, PRDX6 and GPX1. In conclusion, 100 μM acetyl-L-carnitine increased follicle survival and stromal cell density in cultured bovine ovarian tissues but does not influence collagen fibre distribution or the expression of mRNAs for NRF2, SOD, CAT, PRDX6 and GPX1.
The stars of the Milky Way carry the chemical history of our Galaxy in their atmospheres as they journey through its vast expanse. Like barcodes, we can extract the chemical fingerprints of stars from high-resolution spectroscopy. The fourth data release (DR4) of the Galactic Archaeology with HERMES (GALAH) Survey, based on a decade of observations, provides the chemical abundances of up to 32 elements for 917 588 stars that also have exquisite astrometric data from the Gaia satellite. For the first time, these elements include life-essential nitrogen to complement carbon, and oxygen as well as more measurements of rare-earth elements critical to modern-life electronics, offering unparalleled insights into the chemical composition of the Milky Way. For this release, we use neural networks to simultaneously fit stellar parameters and abundances across the whole wavelength range, leveraging synthetic grids computed with Spectroscopy Made Easy. These grids account for atomic line formation in non-local thermodynamic equilibrium for 14 elements. In a two-iteration process, we first fit stellar labels to all 1 085 520 spectra, then co-add repeated observations and refine these labels using astrometric data from Gaia and 2MASS photometry, improving the accuracy and precision of stellar parameters and abundances. Our validation thoroughly assesses the reliability of spectroscopic measurements and highlights key caveats. GALAH DR4 represents yet another milestone in Galactic archaeology, combining detailed chemical compositions from multiple nucleosynthetic channels with kinematic information and age estimates. The resulting dataset, covering nearly a million stars, opens new avenues for understanding not only the chemical and dynamical history of the Milky Way but also the broader questions of the origin of elements and the evolution of planets, stars, and galaxies.