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Rare earth elements (REEs) preserved in speleothems have garnered increasing attention as ideal proxies for the paleoenvironmental reconstruction. However, due to their typically low contents in stalagmites, the availability of stalagmite-based REE records remains limited. Here we present high-resolution REEs alongside oxygen isotope (δ18O) records in stalagmite SX15a from Sanxing Cave, southwestern China (110.1–103.3 ka). This study demonstrates that REE records could provide useful information for the provenance and formation process of the stalagmite, due to consistent distribution pattern across different periods indicating stable provenance. More interestingly, the total REE (ΣREE) record could serve as an effective indicator to reflect local hydrological processes associated with monsoonal precipitation. During Marine Isotopic Stage (MIS) 5d, a relatively low ΣREE content is consistent with the positive SX15a δ18O and negative NGRIP δ18O, reflecting a dry-cold environment; while during MIS 5c, a generally high ΣREE content suggests a humid-warm circumstance. Furthermore, the ΣREE record captured four prominent sub-millennial fluctuations within the Greenland interstadial 24 event, implying a combined influence by the regional climate and local soil redox conditions. Our findings indicate that the stalagmite-based REE records would be a useful proxy for better understanding of past climate and environment changes.
While the literature has largely focused on legal challenges to public healthcare rationing decisions, claims against private insurance companies in voluntary health insurance (VHI) schemes have received less attention. This paper aims to fill this gap by analysing a representative sample of 1,547 court of appeal decisions related to treatment funding claims filed against private insurance companies in Brazil from 2018 to 2021. Courts decided 83.6% of cases in favour of patients, ordering VHI companies to fully fund the claimed treatment. Patients´ rate of success is even higher (96%) in the cases in which insurance companies denied coverage on the grounds that the claimed treatment was not listed in the benefits package mandated by regulation. Court decisions present additional challenges to setting priorities through health technology assessment and explicit packages in the VHI sector. This has broader implications for health care equality and access in Brazil.
Clinical high risk for psychosis (CHR) is often managed with antipsychotic medications, but their effects on neurocognitive performance and clinical outcomes remain insufficiently explored. This study investigates the association between aripiprazole and olanzapine use and cognitive and clinical outcomes in CHR individuals, compared to those receiving no antipsychotic treatment.
Methods
A retrospective analysis was conducted on 127 participants from the Shanghai At Risk for Psychosis (SHARP) cohort, categorized into three groups: aripiprazole, olanzapine, and no antipsychotic treatment. Neurocognitive performance was evaluated using the MATRICS Consensus Cognitive Battery (MCCB), while clinical symptoms were assessed through the Structured Interview for Prodromal Syndromes (SIPS) at baseline, 8 weeks, and one year.
Results
The non-medicated group demonstrated greater improvements in cognitive performance, clinical symptoms, and functional outcomes compared to the medicated groups. Among the antipsychotic groups, aripiprazole was associated with better visual learning outcomes than olanzapine. Improvements in neurocognition correlated significantly with clinical symptom relief and overall functional gains at follow-up assessments.
Conclusions
These findings suggest potential associations between antipsychotic use and cognitive outcomes in CHR populations while recognizing that observed differences may reflect baseline illness severity rather than medication effects alone. Aripiprazole may offer specific advantages over olanzapine, underscoring the importance of individualized risk-benefit evaluations in treatment planning. Randomized controlled trials are needed to establish causality.
We present a high-power mid-infrared single-frequency pulsed fiber laser (SFPFL) with a tunable wavelength range from 2712.3 to 2793.2 nm. The single-frequency operation is achieved through a compound cavity design that incorporates a germanium etalon and a diffraction grating, resulting in an exceptionally narrow seed linewidth of approximately 780 kHz. Employing a master oscillator power amplifier configuration, we attain a maximum average output power of 2.6 W at 2789.4 nm, with a pulse repetition rate of 173 kHz, a pulse energy of 15 μJ and a narrow linewidth of approximately 850 kHz. This achievement underscores the potential of the mid-infrared SFPFL system for applications requiring high coherence and high power, such as high-resolution molecular spectroscopy, precision chemical identification and nonlinear frequency conversion.
This paper presents a millimeter-wave end-fire dual-polarized (DP) array antenna with symmetrical radiation patterns and high isolation. The DP radiation element is formed by integrating a quasi-Yagi antenna (providing horizontal polarization) into a pyramidal horn antenna (providing vertical polarization), resulting in a DP radiation element with a symmetrical radiation aperture. To efficiently feed the DP element while maintaining high isolation, a mode-composite full-corporate-feed network is employed, comprising substrate-integrated waveguide supporting the TE10 mode and substrate-integrated coaxial line supporting the TEM mode. This design eliminates the need for additional transition structures, achieving excellent mode isolation and a reduced substrate layer number. A 1 × 4-element DP array prototype operating at 26.5–29.5 GHz using low temperature co-fired ceramic technology was designed, fabricated, and measured. The test results indicate that the prototype achieves an average gain exceeding 10 dBi for both polarizations within the operating band. Thanks to the symmetrical DP radiation element and mode-composite full-corporate-feed network, symmetrical radiation patterns for both polarizations are observed in both the horizontal and vertical planes, along with a high cross-polarization discrimination of 22 dB and polarization port isolation of 35 dB.
Multimorbidity, especially physical–mental multimorbidity, is an emerging global health challenge. However, the characteristics and patterns of physical–mental multimorbidity based on the diagnosis of mental disorders in Chinese adults remain unclear.
Methods
A cross-sectional study was conducted from November 2004 to April 2005 among 13,358 adults (ages 18–65years) residing in Liaoning Province, China, to evaluate the occurrence of physical–mental multimorbidity. Mental disorders were assessed using the Composite International Diagnostic Interview (version 1.0) with reference to the Diagnostic and Statistical Manual of Mental Disorders (3rd Edition Revised), while physical diseases were self-reported. Physical–mental multimorbidity was assessed based on a list of 16 physical and mental morbidities with prevalence ≥1% and was defined as the presence of one mental disorder and one physical disease. The chi-square test was used to calculate differences in the prevalence and comorbidity of different diseases between the sexes. A matrix heat map was generated of the absolute number of comorbidities for each disease. To identify complex associations and potential disease clustering patterns, a network analysis was performed, constructing a network to explore the relationships within and between various mental disorders and physical diseases.
Results
Physical–mental multimorbidity was confirmed in 3.7% (498) of the participants, with a higher prevalence among women (4.2%, 282) than men (3.3%, 216). The top three diseases with the highest comorbidity rate and average number of comorbidities were dysphoric mood (86.3%; 2.86), social anxiety disorder (77.8%; 2.78) and major depressive disorder (77.1%; 2.53). A physical–mental multimorbidity network was visually divided into mental and physical domains. Additionally, four distinct multimorbidity patterns were identified: ‘Affective-addiction’, ‘Anxiety’, ‘Cardiometabolic’ and ‘Gastro-musculoskeletal-respiratory’, with the digestive-respiratory-musculoskeletal pattern being the most common among the total sample. The affective-addiction pattern was more prevalent in men and rural populations. The cardiometabolic pattern was more common in urban populations.
Conclusions
The physical–mental multimorbidity network structure and the four patterns identified in this study align with previous research, though we observed notable differences in the proportion of these patterns. These variations highlight the importance of tailored interventions that address specific multimorbidity patterns while maintaining broader applicability to diverse populations.
Hand, foot, and mouth disease (HFMD) shows spatiotemporal heterogeneity in China. A spatiotemporal filtering model was constructed and applied to HFMD data to explore the underlying spatiotemporal structure of the disease and determine the impact of different spatiotemporal weight matrices on the results. HFMD cases and covariate data in East China were collected between 2009 and 2015. The different spatiotemporal weight matrices formed by Rook, K-nearest neighbour (KNN; K = 1), distance, and second-order spatial weight matrices (SO-SWM) with first-order temporal weight matrices in contemporaneous and lagged forms were decomposed, and spatiotemporal filtering model was constructed by selecting eigenvectors according to MC and the AIC. We used MI, standard deviation of the regression coefficients, and five indices (AIC, BIC, DIC, R2, and MSE) to compare the spatiotemporal filtering model with a Bayesian spatiotemporal model. The eigenvectors effectively removed spatial correlation in the model residuals (Moran’s I < 0.2, p > 0.05). The Bayesian spatiotemporal model’s Rook weight matrix outperformed others. The spatiotemporal filtering model with SO-SWM was superior, as shown by lower AIC (92,029.60), BIC (92,681.20), and MSE (418,022.7) values, and higher R2 (0.56) value. All spatiotemporal contemporaneous structures outperformed the lagged structures. Additionally, eigenvector maps from the Rook and SO-SWM closely resembled incidence patterns of HFMD.
In this article, we study an optimization problem for a couple including two breadwinners with uncertain life times. Both breadwinners need to choose the optimal strategies for consumption, investment, housing, and life insurance purchasing to maximize the utility. In this article, the prices of housing assets and investment risky assets are assumed to be correlated. These two breadwinners are considered to have dependent mortality rates to include the breaking heart effect. The method of copula functions is used to construct the joint survival functions of two breadwinners. The analytical solutions of optimal strategies can be achieved, and numerical results are demonstrated.
Patients with chronic insomnia are characterized by alterations in default mode network and alpha oscillations, for which the medial parietal cortex (MPC) is a key node and thus a potential target for interventions.
Methods
Fifty-six adults with chronic insomnia were randomly assigned to 2 mA, alpha-frequency (10 Hz), 30 min active or sham transcranial alternating current stimulation (tACS) applied over the MPC for 10 sessions completed within two weeks, followed by 4- and 6-week visits. The connectivity of the dorsal and ventral posterior cingulate cortex (vPCC) was calculated based on resting functional MRI.
Results
For the primary outcome, the active group showed a higher response rate (≥ 50% reduction in Pittsburgh Sleep Quality Index (PSQI)) at week 6 than that of the sham group (71.4% versus 3.6%) (risk ratio 20.0, 95% confidence interval 2.9 to 139.0, p = 0.0025). For the secondary outcomes, the active therapy induced greater and sustained improvements (versus sham) in the PSQI, depression (17-item Hamilton Depression Rating Scale), anxiety (Hamilton Anxiety Rating Scale), and cognitive deficits (Perceived Deficits Questionnaire-Depression) scores. The response rates in the active group decreased at weeks 8–14 (42.9%–57.1%). Improvement in sleep was associated with connectivity between the vPCC and the superior frontal gyrus and the inferior parietal lobe, whereas vPCC-to-middle frontal gyrus connectivity was associated with cognitive benefits and vPCC-to-ventromedial prefrontal cortex connectivity was associated with alleviation in rumination.
Conclusions
Targeting the MPC with alpha-tACS appears to be an effective treatment for chronic insomnia, and vPCC connectivity represents a prognostic marker of treatment outcome.
To summarise the characteristics and postoperative outcomes in paediatric patients with coronary sinus septal defect.
Method:
This retrospective study recruited paediatric patients diagnosed with coronary sinus septal defect from the Guangdong Cardiovascular Institute between 2011 and 2023. Clinical characteristics, echocardiographic parameters, surgical procedures, and postoperative outcomes were collected from electronic health records.
Results:
Among the 68 patients, 50% were male, with a median age of 1.0 years. Four cases (5.9%) were diagnosed during the prenatal period. The proportions of patients with type I, II, III, and IV coronary sinus septal defect were 51.5%, 5.9%, 16.1%, and 26.5%, respectively. The most common coexisting cardiac anomalies were persistent left superior caval vein. Twenty-seven cases were either missed or misdiagnosed by echocardiogram, accounting for 39.7% of the overall cases, with type I being the most frequently missed diagnosis. Fifty-four patients underwent surgery, two patients received transcutaneous intervention, while the remaining patients did not undergo any surgery or intervention. At follow-up, two patients with type I coronary sinus septal defect died from multiorgan dysfunction, and one patient underwent reoperation due to narrowing of the extracardiac tunnel. The remaining patients did not experience any major events and recovered well.
Conclusion:
Paediatric patients with coronary sinus septal defect often do not exhibit specific clinical manifestations. Enhancing our understanding of the anatomic and haemodynamic characteristics of coronary sinus septal defect can improve the diagnostic accuracy of echocardiography. If diagnosis is suspected, confirmation can be obtained by cardiac CT and cardiac magnetic resonance. Accurate preoperative and intraoperative diagnosis of coronary sinus septal defect contributes to high surgical success rates and favourable treatment outcomes.
In the United States, New Delhi metallo-beta-lactamase (NDM)-producing carbapenem-resistant Enterobacterales (CRE) are frequently associated with healthcare encounters. From September 2021 to September 2022, 21 patients with NDM-CRE identified from urine and without healthcare exposure were reported to the Centers for Disease Control and Prevention. Isolates were genetically similar to healthcare-associated strains.
This paper provides an overview of the current status of ultrafast and ultra-intense lasers with peak powers exceeding 100 TW and examines the research activities in high-energy-density physics within China. Currently, 10 high-intensity lasers with powers over 100 TW are operational, and about 10 additional lasers are being constructed at various institutes and universities. These facilities operate either independently or are combined with one another, thereby offering substantial support for both Chinese and international research and development efforts in high-energy-density physics.
Knowledge of the critical periods of crop–weed competition is crucial for designing weed management strategies in cropping systems. In the Lower Yangtze Valley, China, field experiments were conducted in 2011 and 2012 to study the effect of interference from mixed natural weed populations on cotton growth and yield and to determine the critical period for weed control (CPWC) in direct-seeded cotton. Two treatments were applied: allowing weeds to infest the crop or keeping plots weed-free for increasing periods (0, 1, 2, 4, 6, 8, 10, 12, 14, and 20 wk) after crop emergence. The results show that mixed natural weed infestations led to 35- to 55-cm shorter cotton plants with stem diameters 10 to 13 mm smaller throughout the season, fitting well with modified Gompertz and logistic models, respectively. Season-long competition with weeds reduced the number of fruit branches per plant by 65% to 82%, decreasing boll number per plant by 86% to 96% and single boll weight by approximately 24%. Weed-free seed cotton yields ranged from 2,900 to 3,130 kg ha−1, while yield loss increased with the duration of weed infestation, reaching up to 83% to 96% compared with permanent weed-free plots. Modified Gompertz and logistic models were used to analyze the impact of increasing weed control duration and weed interference on relative seed cotton yield (percentage of season-long weed-free cotton), respectively. Based on a 5% yield loss threshold, the CPWC was found to be from 145 to 994 growing degree days (GDD), corresponding to 14 to 85 d after emergence (DAE). These findings emphasize the importance of implementing effective weed control measures from 14 to 85 DAE in the Lower Yangtze Valley to prevent crop losses exceeding a 5% yield loss threshold.
Systematic reviews play important roles but manual efforts can be time-consuming given a growing literature. There is a need to use and evaluate automated strategies to accelerate systematic reviews. Here, we comprehensively tested machine learning (ML) models from classical and deep learning model families. We also assessed the performance of prompt engineering via few-shot learning of GPT-3.5 and GPT-4 large language models (LLMs). We further attempted to understand when ML models can help automate screening. These ML models were applied to actual datasets of systematic reviews in education. Results showed that the performance of classical and deep ML models varied widely across datasets, ranging from 1.2 to 75.6% of work saved at 95% recall. LLM prompt engineering produced similarly wide performance variation. We searched for various indicators of whether and how ML screening can help. We discovered that the separability of clusters of relevant versus irrelevant articles in high-dimensional embedding space can strongly predict whether ML screening can help (overall R = 0.81). This simple and generalizable heuristic applied well across datasets and different ML model families. In conclusion, ML screening performance varies tremendously, but researchers and software developers can consider using our cluster separability heuristic in various ways in an ML-assisted screening pipeline.
We report the first shock-tube experiments on Richtmyer–Meshkov instability at a single-mode light–heavy interface accelerated by a strong shock wave with Mach number higher than 3.0. Under the proximity effect of the transmitted shock and its induced secondary compression effect, the interface profile is markedly different from that in weakly compressible flows. For the first time, the validity of the compressible linear theory and the failure of the impulsive model in predicting the linear amplitude evolution in highly compressible flows are verified through experiments. Existing nonlinear and modal models fail to accurately describe the perturbation evolution, as they do not account for the shock proximity and secondary compression effects on interface evolution. The shock proximity effect manifests mainly in the early stages when the transmitted shock remains close to the interface, while the effect of secondary compression manifests primarily at the period when interactions of transverse shocks occur at the bubble tips. Based on these findings, we propose an empirical model capable of predicting the bubble evolution in highly compressible flows.
The betatron radiation source features a micrometer-scale source size, a femtosecond-scale pulse duration, milliradian-level divergence angles and a broad spectrum exceeding tens of keV. It is conducive to the high-contrast imaging of minute structures and for investigating interdisciplinary ultrafast processes. In this study, we present a betatron X-ray source derived from a high-charge, high-energy electron beam through a laser wakefield accelerator driven by the 1 PW/0.1 Hz laser system at the Shanghai Superintense Ultrafast Laser Facility (SULF). The critical energy of the betatron X-ray source is 22 ± 5 keV. The maximum X-ray flux reaches up to 4 × 109 photons for each shot in the spectral range of 5–30 keV. Correspondingly, the experiment demonstrates a peak brightness of 1.0 × 1023 photons·s−1·mm−2·mrad−2·0.1%BW−1, comparable to those demonstrated by third-generation synchrotron light sources. In addition, the imaging capability of the betatron X-ray source is validated. This study lays the foundation for future imaging applications.
Suicidal ideation (SI) is very common in patients with major depressive disorder (MDD). However, its neural mechanisms remain unclear. The anterior cingulate cortex (ACC) region may be associated with SI in MDD patients. This study aimed to elucidate the neural mechanisms of SI in MDD patients by analyzing changes in gray matter volume (GMV) in brain structures in the ACC region, which has not been adequately studied to date.
Methods
According to the REST-meta-MDD project, this study subjects consisted of 235 healthy controls and 246 MDD patients, including 123 MDD patients with and 123 without SI, and their structural magnetic resonance imaging data were analyzed. The 17-item Hamilton Depression Rating Scale (HAMD) was used to assess depressive symptoms. Correlation analysis and logistic regression analysis were used to determine whether there was a correlation between GMV of ACC and SI in MDD patients.
Results
MDD patients with SI had higher HAMD scores and greater GMV in bilateral ACC compared to MDD patients without SI (all p < 0.001). GMV of bilateral ACC was positively correlated with SI in MDD patients and entered the regression equation in the subsequent logistic regression analysis.
Conclusions
Our findings suggest that GMV of ACC may be associated with SI in patients with MDD and is a sensitive biomarker of SI.
The emotion regulation network (ERN) in the brain provides a framework for understanding the neuropathology of affective disorders. Although previous neuroimaging studies have investigated the neurobiological correlates of the ERN in major depressive disorder (MDD), whether patients with MDD exhibit abnormal functional connectivity (FC) patterns in the ERN and whether the abnormal FC in the ERN can serve as a therapeutic response signature remain unclear.
Methods
A large functional magnetic resonance imaging dataset comprising 709 patients with MDD and 725 healthy controls (HCs) recruited across five sites was analyzed. Using a seed-based FC approach, we first investigated the group differences in whole-brain resting-state FC of the 14 ERN seeds between participants with and without MDD. Furthermore, an independent sample (45 MDD patients) was used to evaluate the relationship between the aforementioned abnormal FC in the ERN and symptom improvement after 8 weeks of antidepressant monotherapy.
Results
Compared to the HCs, patients with MDD exhibited aberrant FC between 7 ERN seeds and several cortical and subcortical areas, including the bilateral middle temporal gyrus, bilateral occipital gyrus, right thalamus, calcarine cortex, middle frontal gyrus, and the bilateral superior temporal gyrus. In an independent sample, these aberrant FCs in the ERN were negatively correlated with the reduction rate of the HAMD17 score among MDD patients.
Conclusions
These results might extend our understanding of the neurobiological underpinnings underlying unadaptable or inflexible emotional processing in MDD patients and help to elucidate the mechanisms of therapeutic response.