Metabolic dysfunction-associated fatty liver disease (MAFLD) is the most common liver disease globally, affecting 1 in 3 Australian adults and up to 39% in rural communities(1). Behaviour changes targeting diet and physical activity to achieve weight loss are considered the cornerstones of MAFLD management. A Mediterranean diet (MedDiet) rich in wholegrains, vegetables, fruits, fish, olives, raw nuts and seeds is recommended in key global guidelines as the optimal dietary pattern for MAFLD(2). Additionally, research evidence indicates moderate-intensity aerobic exercise is effective in reducing liver fat and improving cardiometabolic health(3). Given the higher rates of MAFLD in rural communities and their limited access to healthcare services, digital health interventions present a valuable opportunity to improve the accessibility, availability and personalisation of healthcare services to address this important unmet need. However, no digital interventions to address health risk behaviours in MAFLD including diet and physical activity, are currently available. This research aimed to use best practice co-design methodology to develop a web-based healthy living intervention for people with MAFLD. An iterative co-design process using the Double Diamond Framework, including four key phases was undertaken over 12 months. Twenty-seven adults (≥ 18 years) were recruited from The Alfred Hospital, Australia. This included people with MAFLD (n = 10; 50% female; mean age: 63.6 years), healthcare professionals (HCPs) (n = 17; 59% female; mean age: 37.1 years) [dietitians (n = 5), exercise professionals (n = 6), and clinicians/hepatologists (n = 6)]. Phase 1–discover. Barriers and facilitators were explored through semi-structured interviews to understand the needs of the target population regarding accessibility, appearance, resources and application of the web-based intervention. Interviews were virtual, conducted one-on-one via ZoomTM, transcribed and inductively analysed using NVivo. Phase 2–define. A reflexive thematic analysis identified five key themes within the data. These included: i) web-based functionality, navigation and formatting, ii) holistic behaviour change including MedDiet and physical activity, iii) digital health accessibility, iv) knowledge and resources, and v) intervention duration and reminders. Phase 3–develop. The knowledge gained from this process lead to the development of the web-based intervention taking into consideration expressed preferences for features that can enhance knowledge about the condition, offer dietary and physical activity support via targeted resources and videos, and increase engagement via chat group and frequent reminders. Phase 4–deliver. The co-design has led to the development of a web-based healthy living intervention that will be further evaluated for feasibility and implementation in a pilot trial. The resulting intervention aims to achieve behavioural change and promote healthier living amongst Australians with MAFLD. This knowledge has the potential to drive strategies to reduce barriers to accessing healthcare remotely, making the web-based intervention a valuable tool for both patients and professionals.

The mercury discharged into the sea by the Chisso factory in Minamata, and the radiation released by the Fukushima Daiichi nuclear power plant, are not entirely different “accidents,” although one was the result of a “natural disaster” and one not. Minamata offers hints of future developments as Japan attempts to respond to and recover from Fukushima.

The mercury discharged into the sea by the Chisso factory in Minamata, and the radiation released by the Fukushima Daiichi nuclear power plant, are not entirely different “accidents,” although one was the result of a “natural disaster” and one not. Minamata offers hints of future developments as Japan attempts to respond to and recover from Fukushima.

The mercury discharged into the sea by the Chisso factory in Minamata, and the radiation released by the Fukushima Daiichi nuclear power plant, are not entirely different “accidents,” although one was the result of a “natural disaster” and one not. Minamata offers hints of future developments as Japan attempts to respond to and recover from Fukushima.

Herbaceous perennials must annually rebuild the aboveground photosynthetic architecture from carbohydrates stored in crowns, rhizomes, and roots. Knowledge of carbohydrate utilization and storage can inform management decisions and improve control outcomes for invasive perennials. We monitored the nonstructural carbohydrates in a population of the hybrid Bohemian knotweed [Polygonum ×bohemicum (J. Chrtek & Chrtková) Zika & Jacobson [cuspidatum × sachalinense]; syn.: Fallopia ×bohemica (Chrtek and Chrtková) J.P. Bailey] and in Japanese knotweed [Polygonum cuspidatum Siebold & Zucc.; syn.: Fallopia japonica (Houtt.) Ronse Decr.]. Carbohydrate storage in crowns followed seasonal patterns typical of perennial herbaceous dicots corresponding to key phenological events. Starch was consistently the highest nonstructural carbohydrate present. Sucrose levels did not show a consistent inverse relationship with starch levels. Lateral distribution of starch in rhizomes and, more broadly, total nonstructural carbohydrates sampled before dormancy break showed higher levels in rhizomes compared with crowns. Total nonstructural carbohydrate levels in crowns reached seasonal lows at an estimated 22.6% of crown dry weight after accumulating 1,453.8 growing degree days (GDD) by the end of June, mainly due to depleted levels of stored starch, with the estimated minimum of 12.3% reached by 1,220.3 GDD accumulated by mid-June. Depletion corresponded to rapid development of vegetative canopy before entering the reproductive phase in August. Maximum starch accumulation in crowns followed complete senescence of aboveground tissues by mid- to late October. Removal of aboveground shoot biomass in late June to early July with removal of vegetation regrowth in early September before senescence would optimize the use of time and labor to deplete carbohydrate reserves. Additionally, foliar-applied systemic herbicide translocation to belowground tissue should be maximized with applications in late August through early fall to optimize downward translocation with assimilate movement to rebuild underground storage reserves. Fall applications should be made before loss of healthy leaf tissue, with the window for control typically ending by late September in Minnesota.

Precision or “Personalized Medicine” and “Big Data” are growing trends in the biomedical research community and highlight an increased focus on access to larger datasets to effectively explore disease processes at the molecular level versus the previously common one-size-fits all approach. This focus necessitated a local transition from independent lab and siloed projects to a single software application utilizing a common ontology to create access to data from multiple repositories. Use of a common system has allowed for increased ease of collaboration and access to quality biospecimens that are extensively annotated with clinical, molecular, and patient associated data. The software needed to function at an enterprise level while continuing to allow investigators the autonomy and security access they desire. To identify a solution, a working group comprised of representation from independent repositories and areas of research focus across departments was established and responsible for review and implementation of an enterprise-wide biospecimen management system. Central to this process was the creation of a unified vocabulary across all repositories, including consensus around source of truth, standardized field definitions, and shared terminology.

Christopher Gerteis and Timothy S. George make a case for revisiting Japan's postwar history in the second decade of the twenty-first century. They argue that Japan's problematic responses to the triple disasters of March 2011 warrant re-evaluating the persistent myths of failure and success associated with Japan's “postwar” and “post-bubble” eras.

To optimize the antidepressant efficacy of repetitive transcranial magnetic stimulation (rTMS), it is important to examine the impact of brain state during therapeutic rTMS. Evidence suggests that brain state can modulate the brain’s response to stimulation, potentially diminishing antidepressant efficacy if left uncontrolled or enhancing it with inexpensive psychological or other non-pharmacological methods. Thus, we conducted a PRISMA-ScR-based scoping review to pool studies administering rTMS with psychological and other non-pharmacological methods. PubMed and Web of Science databases were searched from inception to 10 July 2024. Inclusion criteria: neuropsychiatric patients underwent rTMS; studies assessed depressive symptom severity; non-pharmacological tasks or interventions were administered during rTMS, or did not include a wash-out period. Of 8,442 studies, 20 combined rTMS with aerobic exercise, bright light therapy, cognitive training or reactivation, psychotherapy, sleep deprivation, or a psychophysical task. Meta-analyses using random effects models were conducted based on change scores on standardized scales. The effect size was large and therapeutic for uncontrolled pretest-posttest comparisons (17 studies, Hedges’ g = −1.91, (standard error) SE = 0.45, 95% (confidence interval) CI = −2.80 to −1.03, p < 0.01); medium when studies compared active combinations with sham rTMS plus active non-pharmacological methods (8 studies, g = −0.55, SE = 0.14, 95% CI = −0.82 to −0.28, p < 0.01); and non-significant when active combinations were compared with active rTMS plus sham psychological methods (4 studies, p = 0.96). Attempts to administer rTMS with non-pharmacological methods show promise but have not yet outperformed rTMS alone.

We consider pricing of a specialised critical illness and life insurance contract for breast cancer (BC) risk. We compare (a) an industry-based Markov model with (b) a recently developed semi-Markov model, which accounts for unobserved BC cases and progression through clinical stages of BC, and (c) an alternative Markov model derived from (b). All models are calibrated using population data in England and data from the medical literature. We show that the semi-Markov model aligns best with empirical evidence. We then consider net premiums of specialized life insurance products under various scenarios of cancer diagnosis and treatment. The results show strong dependence on the time spent with diagnosed or undiagnosed pre-metastatic BC. This proves to be significant for refining cancer survival estimates and accurately estimating related age dependence by cancer stage. In contrast, the industry-based model, by overlooking this critical factor, is more sensitive to the model assumptions, underscoring its limitations in cancer estimates.

A least-squares algorithm for fitting ultrametric and path length or additive trees to two-way, two-mode proximity data is presented. The algorithm utilizes a penalty function to enforce the ultrametric inequality generalized for asymmetric, and generally rectangular (rather than square) proximity matrices in estimating an ultrametric tree. This stage is used in an alternating least-squares fashion with closed-form formulas for estimating path length constants for deriving path length trees. The algorithm is evaluated via two Monte Carlo studies. Examples of fitting ultrametric and path length trees are presented.

A simplified method of obtaining sums of squares and sums of cross products by the use of punch card equipment is described. Application of the method has revealed several advantages, which are noted.

The aim of this study was to determine whether there was a significant change in cardiac [123I]-metaiodobenzylguanidine uptake between baseline and follow-up in individuals with mild cognitive impairment with Lewy bodies (MCI-LB) who had normal baseline scans. Eight participants with a diagnosis of probable MCI-LB and a normal baseline scan consented to a follow-up scan between 2 and 4 years after baseline. All eight repeat scans remained normal; however, in three cases uptake decreased by more than 10%. The mean change in uptake between baseline and repeat was −5.2% (range: −23.8% to +7.0%). The interpolated mean annual change in uptake was −1.6%.

Carl Snyder was one of the most prominent US monetary economists of the 1920s and 1930s. His pioneering work on constructing the empirical counterparts of the terms in the equation of exchange led him to formulate a 4% monetary growth rule. Snyder is especially apposite because he was on the staff of the New York Federal Reserve Bank. Why, despite his pioneering empirical work and his position as an insider, did Snyder fail to effectively challenge the dominant real bills views of the Federal Reserve (Fed)? A short answer is that he did not possess a convincing version of the quantity theory that attributed the Great Depression to a contraction in the money stock produced by the Fed, as opposed to the dominant real bills view attributing it to the collapse of speculative excess.

The ability of a clay mineral surface to function as an acid is not represented by bulk pH measurements. A method using u.v. analysis and organic indicators has been developed to monitor surface acidity. The u.v. organic indicator method enables sensitive in situ quantification of surface-induced protonation in wet or dry clay systems. The clay preparation procedure used yields reproducible acidic behavior.

Children hospitalised with severe malnutrition have high mortality and readmission rates post-discharge. Current milk-based formulations target restoring ponderal growth but not the modification of gut barrier integrity or microbiome which increases the risk of gram-negative sepsis and poor outcomes. We propose that legume-based feeds rich in fermentable carbohydrates will promote better gut health and improve overall outcomes. We conducted an open-label phase II trial at Mbale and Soroti Regional Referral Hospitals, Uganda, involving 160 children aged 6 months to 5 years with severe malnutrition (mid-upper arm circumference (MUAC) < 11·5 cm and/or nutritional oedema). Children were randomised to a lactose-free, chickpea-enriched legume paste feed (LF) (n 80) v. WHO standard F75/F100 feeds (n 80). Co-primary outcomes were change in MUAC and mortality to day 90. Secondary outcomes included weight gain (> 5 g/kg/d), de novo development of diarrhoea, time to diarrhoea and oedema resolution. Day 90 MUAC increase was marginally lower in LF v. WHO arm (1·1 cm (interquartile range (IQR) 1·1) v. 1·4 cm (IQR 1·40), P = 0·09); day 90 mortality was similar (11/80 (13·8 %) v. 12/80 (15 %), respectively, OR 0·91 (95 % CI 0·40, 2·07), P = 0·83). There were no differences in any of the other secondary outcomes. Owing to initial poor palatability of the LF, ten children switched to WHO feeds. Per-protocol analysis indicated a trend to lower day 90 mortality and readmission rates in the LF (6/60 (10 %) and 2/60(3 %)) v. WHO feeds (12/71(17·5 %) and 4/71(6 %)). Further refinement of LF and clinical trials are warranted, given the poor outcomes in children with severe malnutrition.