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Drawing on the extensive history of study of the terms and conditions (T&Cs) and privacy policies of social media companies, this paper reports the results of pilot empirical work conducted in January-March 2023, in which T&Cs were mapped across a representative sample of generative AI providers as well as some downstream deployers. Our study looked at providers of multiple modes of output (text, image, etc.), small and large sizes, and varying countries of origin. Our early findings indicate the emergence of a “platformisation paradigm”, in which providers of generative AI attempt to position themselves as neutral intermediaries similarly to search and social media platforms, but without the governance increasingly imposed on these actors, and in contradiction to their function as content generators rather than mere hosts for third party content.
Hydrothermal vents are known to host unique faunal assemblages supported by chemosynthetic production; however, the fauna associated with inactive sulphide ecosystems remain largely uncharacterised across the global seafloor. In November 2023, a six-rayed starfish was collected from the Semenov hydrothermal field on the Mid-Atlantic Ridge. A combination of morphological and molecular methods has confirmed the identity of this species as Paulasterias mcclaini Mah et al. 2015 (Forcipulatida: Paulasteriidae), providing the first validated record of this family in the Atlantic Ocean. We present an updated morphological description of the species, alongside phylogenetic analysis of the COI, 16S, 12S, and H3 genetic markers. The biogeography of the family is discussed, and previously published records amended.
The Biden administration requested comments regarding “Public and Private Sector Uses of Biometric Technologies” in the Federal Register from October 2021 to January 2022. This generated 130 responses, helped shape the “Blueprint for an AI Bill of Rights,” and resulted in Executive Order 14110 on “Safe, Secure, and Trustworthy Development and Use of Artificial Intelligence.” While the Trump administration immediately rescinded this executive order, these comments provide insight into salient AI biometrics technologies and relevant political players. We first identify AI biometric technologies before asking which institutions and individuals commented (RQ1), and what the substance and tenor of responses were regarding the opportunities and threats posed by AI biometrics (RQ2-a) based on respondent type (RQ2-b). We use text mining and qualitative analyses to illuminate how uncertainty about AI biometric technology in this nascent policy subsystem reflects participants’ language use and policy preferences.
3,4-methylenedioxymethamphetamine (MDMA)-assisted therapy (MDMA-AT) has shown promising safety and efficacy in phase 3 studies of post-traumatic stress disorder, but has not been investigated for a primary diagnosis of major depressive disorder (MDD).
Aim
We aimed to explore the proof of principle and safety as a first study with MDMA-AT for MDD, and to provide preliminary efficacy data.
Method
Twelve participants (7 women, 5 men) with moderate to severe MDD received MDMA in 2 open-label sessions 1 month apart, along with psychotherapy before, during and after the MDMA sessions, between January 2023 and May 2024. The primary outcome measure was mean change in Montgomery–Asberg Depression Rating Scale (MADRS), and the secondary outcome measure was mean change in functional impairment as measured with the Sheehan Disability Scale (SDS), both from baseline to 8 weeks following the second MDMA session. We used descriptive statistics and the two-tailed Wilcoxon signed-rank test to compare baseline and outcome scores. Repeated measures were analysed by a mixed-effects model.
Results
Baseline MADRS was 29.6 (s.d. 4.9). Feasibility was demonstrated with sufficient recruitment and retention. MADRS scores were significantly reduced post treatment compared with baseline (mean difference –19.3, s.e. 2.4, CI –14.8 to –23.8, P < 0.001). SDS scores significantly decreased from baseline (mean difference –11.7, s.e. 2.2, CI –7.5 to –15.9, P = 0.001). There were no adverse events of special interest, and no unexpected or serious adverse events.
Conclusion
The study met the primary objectives of safety and feasibility, and provided indications of efficacy for MDMA-AT for MDD. Further studies with a randomised design are required to confirm these findings.
We investigate the evolution of active galactic nucleus jets on kiloparsec-scales due to their interaction with the clumpy interstellar medium (ISM) of the host galaxy and, subsequently, the surrounding circumgalactic environment. Hydrodynamic simulations of this jet–environment interaction are presented for a range of jet kinetic powers, peak densities of the multiphase ISM, and scale radii of the larger-scale environment – characteristic of either a galaxy cluster or poor group. Synthetic radio images are generated by considering the combination of synchrotron radiation from the jet plasma and free-free absorption from the multiphase ISM. We find that jet propagation is slowed by interactions with a few very dense clouds in the host galaxy ISM, producing asymmetries in lobe length and brightness which persist to scales of tens of kpc for poor group environments. The classification of kiloparsec-scale jets is highly dependent on surface brightness sensitivity and resolution. Our simulations of young active sources can appear as restarted sources, showing double-double lobe morphology, high core prominence (CP $\gt 0.1$), and the expected radio spectra for both the inner- and outer-lobe components. We qualitatively reproduce the observed inverse correlation between peak frequency and source size and find that the peak frequency of the integrated radio spectrum depends on ISM density but not the jet power. Spectral turnover in resolved young radio sources therefore provides a new probe of the ISM.
Healthcare-prescribed opioids are a known contributor to the opioid epidemic. Locally, there was an identified opportunity to improve opioid prescribing practices in cardiac surgical patients. The cardiac surgical team sought to standardise prescribing practices in postoperative patients and reduce opioid prescriptions at discharge. The improvement was undertaken at a large midwestern freestanding children’s hospital with over 400 beds and 120 cardiac surgeries annually. A multidisciplinary team was formed, using the model for Improvement to guide the improvement work. The key improvement interventions included standardised evidence-based prescribing guidelines based patient age and surgical approach, enhanced pain management with non-opioid medications, and integration of prescribing guidelines into the electronic health record. The primary outcome measure was rate of compliance with the prescribing guidelines and secondary measures included morphine equivalent dosing at discharge, opioid-free discharge, and length of stay. A balancing measure of opioid re-prescriptions was tracked. There were 289 patients included in the primary study period (January 2019 through December 2021). Sustainability of key outcomes was tracked though December 2022. The guideline compliance increased from 24% to 100%. The morphine equivalent dosing decreased to 22.5 in 2021 then 0 in 2022, from baseline of 36.25 in 2019. Opioid-free discharges decreased from 8% (2019) to 1.5% (2021) and 0% in 2022. Establishment and compliance with standardised guidelines for post-operative cardiac surgical pain management yielded a reduction in morphine equivalent dosing, an increase opioid-free discharges, and no increase in length of stay or opioid re-prescriptions.
When unexploded ordnance (UXO) is embedded in the body, the effect of explosive weapons used in conflict is amplified. Though relatively rare, such events present potentially devastating consequences for the patient and medical providers as routine diagnostic and therapeutic procedures hold potential to initiate detonation of the embedded UXO (eUXO). The objective is to identify and synthesize available literature relating to the management of eUXO in low resource settings.
Methods
A scoping review was conducted using PRISMA-ScR methodology to evaluate literature in all languages from all date ranges until January 31, 2024, discussing the management of casualties with eUXO, including types of ordnance, injury patterns, diagnostics, resource utilization, surgical interventions, and outcomes.
Results
Search strings identified 3,425 records. After title and abstract screening 3,397 were excluded yielding 18 for full text screening of which 5 were excluded. Therefore 13 reports were included in analysis. Data variable reporting was heterogeneous but themes and subthemes regarding safety, planning and communication emerged.
Conclusions
A scoping review was conducted to identify gaps in existing literature on the management of eUXO in low resource settings. Coordinated engagement from personnel representing a variety of clinical and non-clinical specialties is required to safely manage eUXO.
Augustine’s picture of the Christian life as a voyage to the heavenly homeland is central to his thought and preaching, especially prominent in his sermons on the Psalms. For Augustine, peregrinatio is a defining image for the earthly life as such as well as of the process by which the Christian believer seeks to travel home on the path made by Christ. Augustine’s vivid imagery for this spiritual journey traverses a varied landscape, which this essay traces through a range of his sermons. Augustine’s Christology is particularly powerful in these images, for it is Christ who makes a way across the sea and over land to the homeland. Yet to be able to take this path, the believer must also be taught and inspired by the Holy Spirit to desire this homeland. Augustine’s exhortations to cultivate desire and longing are thus also dominant features of his sermons on this theme.
Non-attendance at out-patient appointments of adult attention-deficit hyperactivity disorder (ADHD) services incurs significant costs and contributes to lost service provision and unmet clinical needs. This cross-sectional study of clinical contacts, between 1 July 2022 and 30 June 2023 in a specialist adult ADHD service, aimed to identify factors, including type of consultation, associated with non-attendance.
Results
Of 3673 organised clinic appointments, 2815 (77%) were attended: 2314 (82%) by telephone and 501 (18%) as in-person appointments; non-attendance rates were 17 and 42%, respectively. Patient characteristics associated with improved attendance included: female gender, age >30 years and presence of other psychiatric diagnoses.
Clinical implications
This study will assist adult ADHD service providers to maximise patient attendance. The role of telephone (or virtual) clinics must be considered. Enhanced appointment reminders and improving access to services targeting at-risk groups could also improve attendance rates.
The covert administration of medicines is associated with multiple legal and ethical issues. We aimed to develop a natural language processing (NLP) methodology to identify instances of covert administration from electronic mental health records. We used this NLP method to pilot an audit of the use of covert administration.
Results
We developed a method that was able to identify covert administration through free-text searching with a precision of 72%. Pilot audit results showed that 95% of patients receiving covert administration (n = 41/43) had evidence of a completed mental capacity assessment and best interests meeting. Pharmacy was contacted for information about administration for 77% of patients.
Clinical implications
We demonstrate a simple, readily deployable NLP method that has potential wider applicability to other areas. This method also has potential to be applied via real-time health record processing to prompt and facilitate active monitoring of covert administration of medicines.
Risks associated with sub-optimal dietary intake are one of the leading factors contributing to mortality and morbidity worldwide(1). Regular and comprehensive data on the intakes of individuals play a key role in informing the development of public health nutrition policy and programs. In low- and lower-middle-income countries (LLMICs), proxy measures of individual intake, such as food balance sheets, are often used. To-date there has been limited application of technology-assisted dietary assessment methods due to resource constraints(2). This study reports on the relative validity of the Voice-Image Solution for Individual Dietary Assessment (VISIDA) system in a sample of Cambodian women and children. The VISIDA system is a dietary assessment system developed specifically for LLMICs. Intake data is collected in the form of image-voice food records (via a smartphone app) where images and voice recordings of food for consumption are collected prior to eating along with any leftovers at the end of the meal. The image-voice food records are then uploaded to the VISIDA web application and processed by trained analysts to produce estimates of individual nutrient intake. Mothers and one of their children (aged ≤ 5 years) from Siem Reap province, Cambodia were recruited. Intake data was collected for each participant using two dietary assessment methods over three recording periods. The mother used the VISIDA image-voice smartphone app to collect intake data on three days for herself and her child in week 1, with this repeated in week 4. In between VISIDA recording periods, intake data was collected on the mother and her child using interviewer-administered 24-hour recalls collected on three days. A linear mixed model approach was used to evaluate differences between the estimated nutrient intakes for the recording periods for mothers and children. The nutrient intakes for a total of 119 mothers and 91 children were included in the analysis. For both mothers and children, intakes for the majority of nutrients were higher from the 24-hour recalls than intakes reported using the VISIDA system. When 24-hour recall intakes were compared to each VISIDA recording period, mothers had a higher number of nutrients with differences that were statistically significantly than children. In general, the VISIDA system produced lower estimates of nutrient intakes for Cambodian mothers and children when compared to intakes from 24-hour recalls. Further evaluations of the VISIDA system in other LLMICs would provide additional insights into the performance of this method for assessing individual dietary intakes in this context.
Physical health checks in primary care for people with severe mental illness ((SMI) defined as schizophrenia, bipolar disorders and non-organic psychosis) aim to reduce health inequalities. Patients who decline or are deemed unsuitable for screening are removed from the denominator used to calculate incentivisation, termed exception reporting.
Aims
To describe the prevalence of, and patient characteristics associated with, exception reporting in patients with SMI.
Method
We identified adult patients with SMI from the UK Clinical Practice Research Datalink (CPRD), registered with a general practice between 2004 and 2018. We calculated the annual prevalence of exception reporting and investigated patient characteristics associated with exception reporting, using logistic regression.
Results
Of 193 850 patients with SMI, 27.7% were exception reported from physical health checks at least once. Exception reporting owing to non-response or declining screening increased over the study period. Patients of Asian or Black ethnicity (Asian: odds ratio 0.72, 95% CI 0.65–0.80; Black: odds ratio 0.86, 95% CI 0.76–0.97; compared with White) and women (odds ratio 0.90, 95% CI 0.88–0.92) had a reduced odds of being exception reported, whereas patients diagnosed with ‘other psychoses’ (odds ratio 1.19, 95% CI 1.15–1.23; compared with bipolar disorder) had increased odds. Younger patients and those diagnosed with schizophrenia were more likely to be exception reported owing to informed dissent.
Conclusions
Exception reporting was common in people with SMI. Interventions are required to improve accessibility and uptake of physical health checks to improve physical health in people with SMI.
C. S. Lewis was an adamant atheist when he entered Oxford University as a student in 1917. By 1931, he was an Oxford don and a Christian. Lewis was someone who did not think highly of climates of opinion, and in his book The Problem of Pain he warned against uncritically going along with them: 'I take a very low view of 'climates of opinion'. In his own subject every man knows that all discoveries are made and all errors corrected by those who ignore the 'climate of opinion'.' A climate of opinion exists today that either intentionally or unintentionally disenchants or debunks C. S. Lewis. In this Element, the author explains Lewis' belief in the existence of the soul and how it related to his conviction that happiness consists of experiences of pleasure and is the purpose of life, God exists, and Christianity is true.
Smooth Infinitesimal Analysis (SIA) is a remarkable late twentieth-century theory of analysis. It is based on nilsquare infinitesimals, and does not rely on limits. SIA poses a challenge of motivating its use of intuitionistic logic beyond merely avoiding inconsistency. The classical-modal account(s) provided here attempt to do just that. The key is to treat the identity of an arbitrary nilsquare, e, in relation to 0 or any other nilsquare, as objectually vague or indeterminate—pace a famous argument of Evans [10]. Thus, we interpret the necessity operator of classical modal logic as “determinateness” in truth-value, naturally understood to satisfy the modal system, S4 (the accessibility relation on worlds being reflexive and transitive). Then, appealing to the translation due to Gödel et al., and its proof-theoretic faithfulness (“mirroring theorem”), we obtain a core classical-modal interpretation of SIA. Next we observe a close connection with Kripke semantics for intuitionistic logic. However, to avoid contradicting SIA’s non-classical treatment of identity relating nilsquares, we translate “=” with a non-logical surrogate, ‘E,’ with requisite properties. We then take up the interesting challenge of adding new axioms to the core CM interpretation. Two mutually incompatible ones are considered: one being the positive stability of identity and the other being a kind of necessity of indeterminate identity (among nilsquares). Consistency of the former is immediate, but the proof of consistency of the latter is a new result. Finally, we consider moving from CM to a three-valued, semi-classical framework, SCM, based on the strong Kleene axioms. This provides a way of expressing “indeterminacy” in the semantics of the logic, arguably improving on our CM. SCM is also proof-theoretically faithful, and the extensions by either of the new axioms are consistent.
Inadequate recruitment and retention impede clinical trial goals. Emerging decentralized clinical trials (DCTs) leveraging digital health technologies (DHTs) for remote recruitment and data collection aim to address barriers to participation in traditional trials. The ACTIV-6 trial is a DCT using DHTs, but participants’ experiences of such trials remain largely unknown. This study explored participants’ perspectives of the ACTIV-6 DCT that tested outpatient COVID-19 therapeutics.
Methods:
Participants in the ACTIV-6 study were recruited via email to share their day-to-day trial experiences during 1-hour virtual focus groups. Two human factors researchers guided group discussions through a semi-structured script that probed expectations and perceptions of study activities. Qualitative data analysis was conducted using a grounded theory approach with open coding to identify key themes.
Results:
Twenty-eight ACTIV-6 study participants aged 30+ years completed a virtual focus group including 1–4 participants each. Analysis yielded three major themes: perceptions of the DCT experience, study activity engagement, and trust. Participants perceived the use of remote DCT procedures supported by DHTs as an acceptable and efficient method of organizing and tracking study activities, communicating with study personnel, and managing study medications at home. Use of social media was effective in supporting geographically dispersed participant recruitment but also raised issues with trust and study legitimacy.
Conclusions:
While participants in this qualitative study viewed the DCT-with-DHT approach as reasonably efficient and engaging, they also identified challenges to address. Understanding facilitators and barriers to DCT participation and DHT interaction can help improve future research design.
This article considers the role of the public humanities in fostering conversations about climate science and policy through a transdisciplinary performance at the University at Buffalo in New York. The Great Lakes Climate Theatre Initiative is a new project that brings together sustainability scientists with theater practitioners to create new and mixed methods for climate preparedness that are both inclusive and impactful. Toward a Climate Haven was the first project conducted by the initiative with the goal of exploring how Buffalo might become a safe and equitable destination for climate migrants. This first project resulted in a public event that combined the performance of a newly-commissioned play, a talkback session, readings from a local youth writing workshop, and a presentation from a local county official. In this article, our team reflects on how we brought these various threads together to leverage the public humanities in the effort to prepare for climate change.
Objectives/Goals: Undergraduate Medical Education (UME) may apply Just-in-Time training (JITT) to provide medical students with learning experiences closely aligned with real-time clinical needs. The purpose of this scoping review is to offer an overview of the implementation of JITT training in UME. Methods/Study Population: Following the five-stage framework by Arksey and O’Malley to methodically collect and analyze studies on JITT in UME, five electronic databases were searched, and a supplemental search for grey literature was conducted. Studies exploring the integration of JITT principles into UME clinical training and their time to follow-up after training were included. Bloom’s Taxonomy was used to assess educational goals of JITT interventions. Results/Anticipated Results: The review yielded 21 studies across 4 countries. The majority were cohort studies (13) and randomized control trials (5). Assessment definitions and use of JITT varied widely. Most studies focused on short-term outcomes, defined by being measured immediately after JITT session (15) or at the end of JITT-based rotation or clerkship (3). Three studies evaluated outcomes at a period longer than 2 weeks after completion of session or clerkship. Attitudes (9), followed by skills (8) were the most common educational goals of intervention. The efficacy and utility of JITT in improving educational goal acquisition was demonstrated in 90% (17/19) of the studies with reported outcomes. Discussion/Significance of Impact: The introduction of JITT in UME has been shown to meet the immediate needs of healthcare environments; however, evidence is limited in the evaluation of longer-term outcomes. Further research to determine the impact of JITT on long-term learning retention and education goal acquisition in UME is merited.