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Obsessive–compulsive disorder (OCD) is associated with an increased risk of cardiometabolic disorders. We developed a lifestyle intervention, named LIFT, aimed at improving lifestyle habits (physical activity, diet, alcohol and tobacco use, stress, sleep) and reducing cardiometabolic risk factors in OCD.
Aims
This study aimed to establish the feasibility and acceptability of LIFT, evaluate its preliminary efficacy and explore experiences of participation.
Method
Individuals with OCD and at least three cardiometabolic risk factors (e.g. physical inactivity, unhealthy diet, overweight/obesity, dyslipidaemia) were offered LIFT, consisting of one individual session to set individual goals, six educational group sessions and 12 exercise group sessions, delivered over 3 months. We collected baseline, post-intervention and 3-month follow-up measures. Preliminary efficacy variables were analysed with linear mixed models and within-group effect sizes. Qualitative interviews were conducted.
Results
Out of 147 screened individuals, 25 were included (68% women, mean age 37.4, s.d. = 10.9). Credibility and satisfaction were high, attrition rates were low (16%) and the programme was generally safe. Recruitment and adherence to the intervention were challenging. Statistically significant improvements were observed in dietary habits, alcohol consumption, stress, OCD symptom severity and general functioning (within-group effect sizes ranging from 0.27 to 0.56). No changes were observed in physical activity, sleep or any physiological or laboratory measures.
Conclusions
Overall, LIFT was a feasible intervention for individuals with OCD. Effects on lifestyle habits, mental health and functioning are promising. Fully powered randomised controlled trials are needed to evaluate its efficacy and cost-effectiveness.
If supposedly homophonous words were acoustically distinct despite sharing phonemic form, theories of mental storage may have to account for the consistent differences with separate storage for each homophone. Previous studies of the homophonous functions or word classes of the English word like showed such subphonemic differences between functions, though some studies also found effects of utterance context alongside these. Schleef & Turton (2018) argued that all these function effects reduce to context effects, since function is not independent of context – for example, quotative like typically occurs before a pause and thus is typically subject to lengthening because of its position, not due to a lexicalised acoustic distinction between functions. Testing this argument with new data from a different regional variety to those used by Schleef & Turton, we only find differences that can be explained by context, in line with their argument. This casts prior findings of acoustic distinctions between like functions in new light, and introduces the need for further research (especially including the frequency of different functions).
Efficient coordination is a major source of efficiency gains. We study in an experimental coordination game with 727 children and teenagers, aged 9 to 18 years, the strategies played in pre-adulthood. In our one-shot, experimental coordination game, we vary the incentives for reaching the more efficient equilibrium and the number of subjects within a group. Looking at strategy choices dependent on age, we do not find robust age effects in the aggregate. Yet, we see that smaller group sizes and larger incentives increase the likelihood of choosing the efficient strategy. The larger strategic uncertainty in larger groups is obviously harmful for overall efficiency. Regarding incentives, we find that increasing the profits in the efficient equilibrium seems to work better than providing a cushion in case of miscoordination. Beliefs play an important role as well, as subjects are more likely to play the efficient strategy when they expect others to do so as well. Our results are robust to controlling for individual risk-, time-, and social preferences.
Mass-casualty incidents (MCI) are a highly important issue in disaster medicine today. In this context, professional first responders play a fundamental role as they provide preparedness and initial care to the injured. The aim of this review is to describe the form and impact of different didactic concepts in triage exercises to prepare for an MCI response.
Methods
A Scoping review search was conducted in the databases PubMed, Medline, and Psyndex as an initial examination of this topic.
Results
Seventeen studies were included in this review. Of the reviewed studies, 52.9% followed a randomized controlled trial design with pre-post intervention measurement. The interventions implemented in the studies were associated with an increase in knowledge and/or practical skills. Of media-based interventions, 42.9% show a comparable and 57.1% greater training effect than conventional teaching methods. According to 4 studies, technical and non-technical aids increase the triage accuracy.
Conclusions
The benefits of media-based interventions and of technical and non-technical aids should be evaluated by a subsequent systematic review with a broader database and search terms of studies. The differences between different triage algorithms need to be investigated in future studies. It must be noted that intervention is preferable to non-intervention.
Plasma-terminating disruptions represent a critical outstanding issue for reactor-relevant tokamaks. ITER will use shattered pellet injection (SPI) as its disruption mitigation system to reduce heat loads, vessel forces and to suppress the formation of runaway electrons. In this paper we demonstrate that reduced kinetic modelling of SPI is capable of capturing the major experimental trends in ASDEX Upgrade SPI experiments, such as dependence of the radiated energy fraction on neon content, or the current quench dynamics. Simulations are also consistent with the experimental observation of no runaway electron generation with neon and mixed deuterium–neon pellet composition. We also show that statistical variations in the fragmentation process only have a notable impact on the disruption dynamics at intermediate neon doping, as was observed in experiments.
Older adults often experience a decline in functional abilities, affecting their independence and mobility at home. Wearable lower-limb exoskeletons (LLEs) have the potential to serve as both assistive devices to support mobility and training tools to enhance physical capabilities. However, active end-user involvement is crucial to ensure LLEs align with users’ needs and preferences. This study employed a co-design methodology to explore home-based LLE requirements from the perspectives of older adults with mobility impairments and physiotherapists. Four older adults with self-reported mobility limitations participated by creating personas to represent different user needs and experiences (i.e., PERCEPT methodology), alongside four experienced physiotherapists who contributed their professional insights. As assistive devices, LLEs were seen as valuable for promoting independence, supporting mobility, and facilitating social participation, with essential activities including shopping, toileting, and outdoor walking. Physiotherapists expressed enthusiasm for integrating LLEs into remote rehabilitation programs, particularly to improve strength, balance, coordination, and walking speed. Key design considerations included a lightweight, discreet device that is easy to don and doff and comfortable for extended wear. Physiotherapists highlighted the potential of digital monitoring to assess physical parameters and personalize therapy. Fatigue emerged as a significant challenge for older adults, reinforcing the need for assistive LLEs to alleviate exhaustion and enhance functional independence. A shortlist of LLE features was drafted and scored, covering activity and design applications. These findings provide valuable insights into the design and usability of home-based LLEs, offering a foundation for developing devices that improve acceptance, usability, and long-term impact on healthy ageing.
Immune dysregulation contributes to the pathophysiology of depression and is a potential link between depression and comorbid medical conditions. DNA methylation is a dynamic transcriptional regulator of the immune system.
Aims
To study changes in DNA methylation of disease- and comorbidity-associated immune genes in patients with and without depression diagnoses from the German BiDirect Study.
Method
We performed a cross-sectional (baseline, y0) and longitudinal (consecutive assessments at 3-year intervals, y0, y3, y6) differential methylation analyses of 382 immune-related genes associated with depression, obesity, diabetes and/or gout in 276 patients with depression and in 207 individuals without a lifetime depression diagnosis from the BiDirect Study. In addition, we applied unsupervised clustering to identify subgroups of individuals with depression based on longitudinal methylation patterns.
Results
There were no significant methylation changes between individuals with depression and controls at baseline. Follow-up analyses used to assess the top (P < 0.05) 151 methylation probes longitudinally identified 42 CpG sites that showed time-dependent changes associated with depression, and defined 3 depression clusters with differential profiles of serum inflammation markers at baseline. The implicated genes corresponded in the majority to those associated with diabetes risk, and were enriched in processes relevant for haematopoiesis.
Conclusions
Our results suggest that immune dysregulation associated with DNA methylation profiles contributes to the pathophysiology of depression and is a plausible link to chronic medical conditions such as diabetes.
How should epistemologists respond to skepticism about knowledge of the external world? Michael Bergmann advocates noninferential antiskepticism. The thought is that, to reply to a skeptical argument, we should start with premises that do not require inference. I argue that Bergmann’s reasoning runs into the problem of easy knowledge and propose an alternative inferential antiskepticism. This view faces the problem of vicious circularity. I agree that, if we go down the inferential path, a certain type of circularity is unavoidable. I deny, however, that this type of circularity is vicious.
Family caregivers play a critical yet often overlooked role in healthcare, facing the dual challenge of providing clinical care while managing their emotional well-being. Although several studies have investigated the supportive care needs and services for caregivers of advanced cancer patients integrated into specialized palliative care inpatient units, little is known about cancer caregiver integration and support structures in German outpatient cancer care. This qualitative study addresses this gap by exploring the experiences of family caregivers in Germany, using a dyadic approach to assess their needs, identify referral strategies, and evaluate oncologists’ perspectives on improving caregiver integration and support.
Methods
Thematic analysis was conducted on semi-structured interviews with 14 advanced cancer patients, 15 family caregivers, and 3 oncologists. MAXQDA software facilitated the identification of key themes and codes.
Results
Three interconnected themes emerged: (1) The Impact of Illness on the Dyadic Relationship, (2) Communication with Physicians and Understanding of Healthcare Information, and (3) Challenges and Preferences in Navigating Healthcare Services and Psychosocial Support.
Significance of results
The findings highlight the need for enhanced support in caregiving to improve cancer care quality, emphasizing that early palliative care integration is vital for addressing caregiver needs as a core component of comprehensive cancer care. Healthcare practices should adopt personalized, proactive support strategies from diagnosis, implement regular needs assessments, and leverage digital healthcare tools to enhance the efficacy and efficiency of caregiver support.
This paper investigates the collusive and competitive effects of algorithmic price recommendations on market outcomes. These recommendations are often non-binding and common in many markets. We develop a theoretical framework and derive two algorithms that recommend collusive pricing strategies. Utilizing a laboratory experiment, we find that sellers condition their prices on the recommendation of the algorithms. The algorithm with a soft punishment strategy lowers market prices and has a pro-competitive effect. The algorithm that recommends a subgame perfect equilibrium strategy increases the range of market outcomes, including more collusive ones.
This paper reviews current theoretical and numerical approaches to optimization problems governed by partial differential equations (PDEs) that depend on random variables or random fields. Such problems arise in many engineering, science, economics and societal decision-making tasks. This paper focuses on problems in which the governing PDEs are parametrized by the random variables/fields, and the decisions are made at the beginning and are not revised once uncertainty is revealed. Examples of such problems are presented to motivate the topic of this paper, and to illustrate the impact of different ways to model uncertainty in the formulations of the optimization problem and their impact on the solution. A linear–quadratic elliptic optimal control problem is used to provide a detailed discussion of the set-up for the risk-neutral optimization problem formulation, study the existence and characterization of its solution, and survey numerical methods for computing it. Different ways to model uncertainty in the PDE-constrained optimization problem are surveyed in an abstract setting, including risk measures, distributionally robust optimization formulations, probabilistic functions and chance constraints, and stochastic orders. Furthermore, approximation-based optimization approaches and stochastic methods for the solution of the large-scale PDE-constrained optimization problems under uncertainty are described. Some possible future research directions are outlined.
The radome of weather radars can be covered with a layer of water, degrading the quality of the radar products. Considering a simplified setup with a planar replica of the Swiss weather radars’ radome, we measure and model analytically its scattering parameters, with and without water. The measured reflectance of the dry radome replica agrees well with the one modeled according to the manufacturer specifications. Water forms droplets on the hydrophobic surface, but water films thicker than 1 mm can be created. Meteorologically more realistic thinner water films are expected on old radomes that have become hydrophilic with aging. Using hygroscopic silk and cotton tissues, we empirically imitate water films as thin as less than 0.1 mm. The measurements align with the simple analytical model of uniform plane wave incidence on the radome and water film but could be further improved by taking refraction and bending of the radome replica into account. Simulations with the General Reflector Antenna Software Package (GRASP) from TICRA complement the study for a representative setup with a spherical radome.
In the dynamical systems approach to turbulence, unstable periodic orbits (UPOs) provide valuable insights into system dynamics. Such UPOs are usually found by shooting-based Newton searches, where constructing sufficiently accurate initial guesses is difficult. A common technique for constructing initial guesses involves detecting recurrence events by comparing past and future flow states using their $L_2$-distance. An alternative method uses dynamic mode decomposition (DMD) to generate initial guesses based on dominant frequencies identified from a short time series, which are signatures of a nearby UPO. However, DMD struggles with continuous symmetries. To address this drawback, we combine symmetry-reduced DMD (SRDMD) introduced by Marensi et al. (2023, J. Fluid Mech., vol. 954, A10), with sparsity promotion. This combination provides optimal low-dimensional representations of the given time series as a time-periodic function, allowing any time instant along this function to serve as an initial guess for a Newton solver. We also discuss how multi-shooting methods operate on the reconstructed trajectories, and we extend the method to generate initial guesses for travelling waves. We demonstrate SRDMD as a method complementary to recurrent flow analysis by applying it to data obtained by direct numerical simulations of three-dimensional plane Poiseuille flow at the friction Reynolds number $\textit{Re}_\tau \approx51$ ($\textit{Re}=802$), explicitly taking a continuous shift symmetry in the streamwise direction into account. The resulting unstable relative periodic orbits cover relevant regions of the state space, highlighting their potential for describing the flow.
Accumulating evidence shows that an increasing number of children and young people (CYP) are reporting mental health problems.
Aims
To investigate emotional disorders (anxiety or depression) among CYP in England between 2004 and 2017, and to identify which disorders and demographic groups have experienced the greatest increase.
Method
Repeated cross-sectional, face-to-face study using data from the Mental Health of Children and Young People surveys conducted in 2004 and 2017, allowing use of nationally representative probability samples of CYP aged 5–16 years in England. A total of 13 561 CYP were included across both survey waves (6898 in 2004 and 6663 in 2017). We assessed the prevalence of any emotional, anxiety and depressive disorder assessed using the Development and Well-Being Assessment and classified according to ICD-10 criteria.
Results
The prevalence of emotional disorders increased from 3.9% in 2004 to 6.0% in 2017, a relative increase of 63% (relative ratio 1.63, 95% CI 1.38, 1.91). This was largely driven by anxiety disorders, which increased from 3.5 to 5.4% (relative ratio 1.63, 95% CI 1.37, 1.93). The largest relative changes were for panic disorder, separation anxiety, social phobia and post-traumatic stress disorder. Changes were similar for different genders and socioeconomic groups, but differed by ethnicity: the most pronounced increase was among White CYP (relative ratio 1.88, 95% CI 1.59, 2.24), compared with no clear change for Black and minority ethnic CYP (relative ratio 0.85, 95% CI 0.52, 1.39). Comorbid psychiatric conditions were present in over a third of CYP with emotional disorders, with the most common being conduct disorder.
Conclusions
Between 2004 and 2017, the increase in emotional disorders among CYP in England was largely driven by anxiety disorders. Socioeconomic inequalities did not narrow. Disaggregating by ethnicity, change was evident only in White CYP, suggesting differential trends in either risk exposure, resilience or reporting by ethnicity.
To describe the process of the development of evidence-based guidelines on the assessment and clinical management of internal contamination with transuranic actinides (specifically plutonium, americium, and curium) in incidents where workers, emergency responders, and the public might uptake these radionuclides internally through inhalation, ingestion, or wound contamination.
Methods
The World Health Organization (WHO) set up a guidelines development group (GDG) that follows the protocol required for producing evidence-based recommendations as described elsewhere. The GRADE® approach was applied throughout the process, including developing research questions formulation, prioritization and rating the importance for the outcomes, assessing the certainty of the evidence, considering contextual factors, and making recommendations.
Results
Through 3 working group meetings held 2023-2024, the GDG defined and rated patient-important health outcomes, and evidence gathered through systematic reviews and its certainty rating, working towards formulating the recommendations using an evidence-to-recommendation (EtR) framework.
Conclusions
The WHO protocol for developing health care management guidelines uses a transparent and robust evidence-based GRADE® approach. Once published, these guidelines will provide the first evidence-based recommendations for assessment and clinical management of internal contamination with transuranic actinides.
The term ‘water pocket’ describes invisible en- and subglacial water reservoirs that can cause sudden glacial outburst floods. However, there is currently no consensus on its definition and the formation and rupture mechanisms of water pockets remain poorly understood. This study aims to understand the mechanisms behind water pocket outburst floods (WPOFs) from alpine glaciers by analyzing their spatial and temporal distribution, pre-event meteorological conditions and the glacio-geomorphic features of the glaciers from which the floods originate. To this end, we updated an inventory of known WPOFs in the Swiss Alps to 91 events from 37 individual glaciers. Most WPOFs occurred between June and September, likely linked to meltwater input. Meteorological data indicate anomalously high temperatures during the days preceding most events and heavy precipitation on 25% of days for which WPOFs occur, indicating that water pockets typically rupture during periods of high water input. We propose four mechanisms of water pocket formation: temporary subglacial channel blockage (which is the mechanism suggested most often for our inventory), hydraulic barriers, water-filled crevasses and accumulation of liquid water behind barriers of cold ice (thermal barriers). Overall, our analysis highlights the challenge of understanding WPOFs due to the subsurface nature of water pockets, emphasizing the need for field-based research to improve their detection and monitoring.
This collection of articles by an international group of leading experts has its special focus on the relevance of Karl Jaspers's philosophy for the social sciences. It also includes classical evaluations of Jaspers's thinking by renowned authors Talcott Parsons and Jürgen Habermas. Several chapters are devoted to the relationship between Jaspers and his teacher (Max Weber), his famous student (Hannah Arendt) and crucial figures in his intellectual world (Wilhelm Dilthey, Georg Simmel). Others deal with his relevance for disciplines from psychiatry to the study of religion and the historico-sociological research about the Axial Age, a term coined by Jaspers. In his introduction, editor Hans Joas tries to systematise Jaspers's relevance for the contemporary social sciences and to explain why Parsons had called him a 'social scientist's philosopher'.
The book promises to become an indispensable source in the re-evaluation of Jaspers' thinking in the years to come.
Efforts to drain Lake Maliq, in the Korça Basin of eastern Albania, during the 1940s and 1950s revealed waterlogged wooden structures that were excavated in the 1970s and identified as Neolithic pile-dwellings. Fifty years later, new excavations are exposing the exceptional organic preservation and complex stratigraphy of the Dunavec site. Through a combination of dendrochronological and radiocarbon dating, the authors provide the first secure absolute dates for the structures, placing early activity at the site within the beginning of the fifty-third century BC and creating a chronological anchor for our understanding of Neolithic communities in the western Balkans.