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Assessing systemic risk presents a significant challenge in finance and insurance, where conditional risk measures are essential for capturing contagion effects. This paper introduces two novel systemic risk measures – conditional interval value-at-risk (CoIVaR) and conditional interval expected shortfall (CoIES) – which extend traditional metrics by incorporating interval-based uncertainty. A formal theoretical framework is developed for both measures, offering a detailed characterization of their key properties and risk contributions. We then propose a comprehensive comparison methodology for systemic risk assessment, leveraging stochastic orders, dependence structures, and marginal distributions to establish conditions for ranking risk vectors. Finally, through numerical experiments and real-world stock market applications, we demonstrate the practical utility of CoIVaR and CoIES in quantifying systemic risk under uncertainty. The findings provide valuable insights into systemic risk propagation and establish a robust foundation for risk management in interconnected financial systems.
Remote injury assessment during natural disasters poses major challenges for healthcare providers due to the inaccessibility of disaster sites. This study aimed to explore the feasibility of using artificial intelligence (AI) techniques for rapid assessment of traumatic injuries based on gait analysis.
Methods
We conducted an AI-based investigation using a dataset of 4500 gait images across 3 species: humans, dogs, and rabbits. Each image was categorized as either normal or limping. A deep learning model, YOLOv5—a state-of-the-art object detection algorithm—was trained to identify and classify limping gait patterns from normal ones. Model performance was evaluated through repeated experiments and statistical validation.
Results
The YOLOv5 model demonstrated high accuracy in distinguishing between normal and limp gaits across species. Quantitative performance metrics confirmed the model’s reliability, and qualitative case studies highlighted its potential application in remote, fast traumatic assessment scenarios.
Conclusions
The use of AI, particularly deep convolutional neural networks like YOLOv5, shows promise in enabling fast, remote traumatic injury assessment during disaster response. This approach could assist healthcare professionals in identifying injury risks when physical access to patients is restricted, thereby improving triage efficiency and early intervention.
Anxiety is a persistent trait that disrupts functioning and increases the risk of severe consequences, while reward processing has garnered attention in anxiety research. Here, we report a critical concern in reward processing among individuals with anxiety: although anxious individuals may show similar reward processing abilities as non-anxious individuals in typical environments, they are more vulnerable to disruptions in positive emotions caused by frustrative non-reward, leading to maladaptive reward processing patterns.
Methods
The functional magnetic resonance imaging (fMRI) was used in this study. A total of 66 participants were recruited for the experiment, with 33 in the high anxiety (HA) group and 33 in the low anxiety (LA) group. The simulation of frustrative non-reward was conducted during fMRI scanning.
Results
Under the low frustration condition, the HA group exhibited task accuracy comparable to the LA group and showed greater activation in visual processing regions (inferior occipital gyrus, superior occipital gyrus, angular gyrus) and cognitive control areas (precuneus, precentral gyrus) during attentional reorienting following frustration. However, in the high frustration condition, the HA group displayed significantly lower accuracy, with maladaptive information processing patterns observed in several brain regions associated with the cognitive-emotional control system (cuneus-precuneus, anterior cingulate cortex, precentral gyrus, inferior frontal gyrus, superior frontal gyrus, orbitofrontal cortex, and amygdala).
Conclusions
This demonstration of two contrasting processing patterns deepens the current understanding of reward processing in anxiety. It also holds significance for a broader understanding of the risk factors in cognitive processing among individuals with anxiety.
Previous studies highlighted the health benefits of coffee and tea, but they only focused on the comparisons between different consumptions. Consequently, the association estimate lacked a clear interpretation, as the substitution of beverages and distribution of doses were not explicitly prescribed. We focused on the ‘relative association’ to ascertain the optimal consumption strategy (including total intake and optimal allocation strategy) for coffee, tea and plain water associated with decreased mortality. Self-reported coffee, tea and plain water intake were used from the UK Biobank. Within a compositional data analysis framework, a multivariate Cox model was used to assess the relative associations after adjusting for a range of potential confounders. The lower mortality risk was observed with at least approximately 7–8 drinks/d of total consumption. When the total intake > 4 drinks/d, substituting plain water with coffee or tea was linked to reduced mortality; nevertheless, the benefit was not seen for ≤ 4 drinks/d. Besides, a balanced consumption of coffee and tea (roughly a ratio of 2:3) associated with the lowest hazard ratios of 0·55 (95 % CI 0·47, 0·64) for all-cause mortality, 0·59 (95 % CI 0·48, 0·72) for cancer mortality, 0·69 (95 % CI 0·49, 0·99) for CVD mortality, 0·28 (95 % CI 0·15, 0·52) for respiratory disease mortality and 0·35 (95 % CI 0·15, 0·82) for digestive disease mortality than other combinations. These results highlight the importance of the rational combination of coffee, tea and plain water, with particular emphasis on ensuring adequate total intake, offering more comprehensive and explicit guidance for individuals.
Perimenopausal women often experience physiological and psychological decline due to the effects of oestrogen fluctuations and the decline of ovarian function, leading to significantly increased depression rates, decreases in the quality of life and mental health issues. Studies have shown that the gut microbiota exerts anti-perimenopausal depression (PMD) effects via the microbiota-gut-brain (MGB) axis, the mechanisms of which may be related to inflammation. In this review, we discuss the effects and mechanisms of gut microbiota in PMD and provide new insights for future PMD treatment.
Methods
This review elaborates on the role of MGB axis in PMD from different aspects of inflammation, including gut microbiota metabolites, inflammatory signaling pathways, and clinical applications.
Results
Disorders of gut microbiota and decreased levels of gut microbiota metabolites (short-chain fatty acids, monoamine neurotransmitters) may cause PMD. The mechanism of intestinal microbiota-mediated inflammation may be related to TLR4/NF-κB pathway, NOD-like receptor protein 3 (NLRP3) inflammasome pathway and JAK-STAT pathway. At the same time, it was found that gut microbiota (probiotics, prebiotics, etc.) had good therapeutic potential in the treatment of PMD.
Conclusions
MGB axis mediated inflammation may play an important role in PMD. The application of gut microbiota in the treatment of PMD patients has profound clinical transformation value, but a lot of efforts are still needed.
Transoral robotic surgery has gained much recognition in the surgical management of obstructive sleep apnoea, allowing for improved surgical access and precise dissection around the narrow surgical field. However, it is associated with a steeper learning curve and may give rise to significant morbidity especially amongst less experienced surgeons.
Methods
Through a comprehensive literature search, this review summarises patient selection for transoral robotic surgery as well as peri-operative considerations and management.
Results
Apart from technical mastery, successful transoral robotic surgery require for the surgeon to be proficient with navigating the entire care continuum beginning with patient selection to management of post-operative complications.
Conclusion
Transoral robotic surgery remains a promising tool for surgical treatment of patients with obstructive sleep apnoea. This review provides an overview of the surgical application of transoral robotic surgery in obstructive sleep apnoea, together with practical guidance for the sleep surgeon.
This article reconstructs the mining practices and social activities of Chinese migrants in Maliwun, a tin-rich Burmese village on the Siam-Burma border between the 1840s and 1890s. Despite its natural resources and repeated mining attempts by various stakeholders, Maliwun could not materialise its potential and was slow in tin production and community development throughout this period. By focusing on the internal dynamics among its Chinese miners, especially around the rivalling Chinese “secret societies,” this article situates the frontier mining settlement within a larger regional network of the Southeast Asian Chinese and traces its Chinese community’s evolving relationships with fellow countrymen along the southern Siamese and northern Malayan coastlines. It argues that grassroots organisations played a crucial role in the early formation of this frontier Chinese migrant community, which was sitting at the intersection of political, labour, resource, gender, and ethnic frontiers and exhibited key features of fluid boundaries and transnational networks. Yet, these impacts should not be overstated, individually or collectively. The slow development of Maliwun calls for a careful reassessment of the limitation of roles played by porous borders, hybrid interactions, and transnational networks at a historic frontier.
Evaluators, tasked with making funding decisions under conditions of incomplete information and uncertainty, are particularly susceptible to the influence of temporality and gender expectations. Drawing on the literature on signaling theory and gender expectations, this research examines the importance of past temporal focus in determining innovation funding decisions. Our empirical evidence suggests that innovation projects that focus on past events are more likely to receive favorable evaluations as past temporal focus signals better learning capacity among innovators. Moreover, we build on the signal credibility and visibility literature to support the notion that female-dominated presenting teams that emphasize past actions receive higher evaluations because the learning capacity signal is deemed more credible for women and female evaluators are more reactive to past-related signals, leading to higher evaluations for innovations with a past-focused narrative. Our study contributes to the literature on temporal focus and signal effectiveness and provides implications for mitigating the gender gap in accessing funding through temporal rhetoric.
To evaluate the prognostic value of electrocardiographic ventricular repolarisation parameters in children with dilated cardiomyopathy.
Methods:
A retrospective study was conducted involving 89 children with dilated cardiomyopathy [age 5.24 (4.32, 6.15) years] as the research group, and a control group consisting of 80 healthy children matched for age and sex. Within the research group, there were 76 cases in the survival subgroup and 13 cases in the death subgroup. Ventricular repolarisation parameters were measured.
Results:
(1) Compared to the control group, both QTcmax and QTcmin were significantly prolonged in the research group (P < 0.01). Additionally, Tp-Te /QT ratios for leads III, aVL, V1, V2, and V3 showed an increase (P < 0.05), while T-wave amplitudes for leads I, II, aVL, aVF, V4, V5, and V6 exhibited a decrease (P < 0.05). (2) In comparison to the survival subgroup, the diameters of the LV, RV, LA, and RA in the death subgroup were enlarged, while the left ventricular ejection fraction and eft ventricular fractional shortening were decreased (P < 0.05). The Tp-Te /QT ratios for leads aVR, V5, and V6 also increased notably (P < 0.05 or P < 0.01). The T-wave amplitude readings from leads II, aVF, and V6 demonstrated significant reductions (P < 0.05).
Conclusion:
Abnormal ventricular repolarisation parameters were found in dilated cardiomyopathy children. Increased Tp-Te /QT ratios in aVR, V5, and V6 leads and decreased T-wave amplitudes in II, aVF, and V6 leads were risk factors for predicting mortality in children with dilated cardiomyopathy.
Previous studies have reported comorbidities of autoimmune thyroid disorders (AITD), including Hashimoto’s disease (HT) and Graves’ disease (GD), and celiac disease (CeD), as well as the possible beneficial effects of a gluten-free diet (GFD) on AITD. Nonetheless, it remains uncertain whether there is a genetic causal relationship between AITD and CeD, while the beneficial effects on a GFD are controversial. This study aim to explore the causal relationship between CeD and AITD, particularly with HT, and to determine whether a GFD is beneficial for AITD. We performed a two-sample Mendelian Randomization (MR) analysis on data from the largest meta-analysis summary statistics of AITD, CeD and GFD. Genetic instrumental variables were established by pinpointing single nucleotide polymorphisms (SNPs) that relate to corresponding factors. In assessing sensitivity and heterogeneity, we conducted examinations of MR Egger, weighted median, simple mode, weighted mode, and MR Egger intercept tests. HT was found to play a pathogenic role in increasing the risk of CeD (ORIVW = 1.544 [95%CI 1.153-2.068], p = 0.00355), and our Mendelian randomization study does not support genetic liability related to CeD with GD (Graves’ disease) and GFD with AITD. This study supports the positive correlation between HT risk and CeD risk, while GFD has no protective effect on AITD and may exert its effect through other mechanisms. These findings provide valuable insights into potential targets for disease intervention and treatment at the genetic level.
While existing research on policy diffusion has provided substantial evidence regarding the drivers of policy adoption across jurisdictions, limited attention has been given to the dynamics of policy textual learning across different levels of government. We fill this gap by using regression analysis to examine the patterns of policy textual learning evident in the clause similarity of seven environmental statutory policies in China. Within China’s decentralized and multilevel environmental governance, our findings reveal that horizontal policy textual learning is more prominent than vertical learning. Temporal distance negatively impacts policy textual learning, whereas spatial distance, contrary to traditional policy diffusion perspectives, does not universally explain multilevel policy textual learning. Additionally, subsequent versions of policy texts are not necessarily similar to earlier ones, challenging conventional assumptions about the adoption and adaptation of policies over time.
We undertake a comprehensive investigation into the distribution of in situ stars within Milky Way-like galaxies, leveraging TNG50 simulations and comparing their predictions with data from the H3 survey. Our analysis reveals that 28% of galaxies demonstrate reasonable agreement with H3, while only 12% exhibit excellent alignment in their profiles, regardless of the specific spatial cut employed to define in situ stars. To uncover the underlying factors contributing to deviations between TNG50 and H3 distributions, we scrutinise correlation coefficients among internal drivers (e.g. virial radius, star formation rate [SFR]) and merger-related parameters (such as the effective mass-ratio, mean distance, average redshift, total number of mergers, average spin-ratio, and maximum spin alignment between merging galaxies). Notably, we identify significant correlations between deviations from observational data and key parameters such as the median slope of virial radius, mean SFR values, and the rate of SFR change across different redshift scans. Furthermore, positive correlations emerge between deviations from observational data and parameters related to galaxy mergers. We validate these correlations using the Random Forest Regression method. Our findings underscore the invaluable insights provided by the H3 survey in unravelling the cosmic history of galaxies akin to the Milky Way, thereby advancing our understanding of galactic evolution and shedding light on the formation and evolution of Milky Way-like galaxies in cosmological simulations.
Broad-spectrum antibiotic use in febrile neutropenia is often driven by concerns for severe and drug-resistant infections. In select patients who do not have an active infection and improve, their prolonged and unnecessary use contributes to antimicrobial resistance, drug toxicity, and increased healthcare costs. We describe the implementation of an antibiotic de-escalation protocol to reduce inappropriate antibiotic use in febrile neutropenia among hematology patients.
Methods:
We conducted baseline analysis (January–June 2024) of antibiotic use in febrile neutropenia cases admitted under hematology. Interventions included the (i) development of an antibiotic de-escalation protocol to guide clinical management, (ii) a roadshow to educate and improve uptake of this protocol, and (iii) regular feedback via “report cards” for hematology teams. The primary outcome was the proportion of febrile neutropenia cases with inappropriate antibiotic use, with secondary measures including adverse outcomes (in-hospital mortality, Clostridioides difficile infection, need for intensive care).
Results:
Baseline data indicated inappropriate antibiotic use rates of 45.5–66.7% per month from January to June 2024, with 13–28 days of inappropriate therapy. The protocol was developed in July 2024, with a subsequent roadshow to promote its uptake. Regular feedback was provided in the form of “report cards” every 2-monthly thereafter. Post-intervention, inappropriate antibiotic use decreased to a median of 23.35% from July to December 2024, with no observed increase in adverse outcomes.
Conclusions:
The implementation of a structured de-escalation protocol, combined with frequent education and feedback, effectively reduced inappropriate antibiotic use in febrile neutropenia without compromising patient safety.
We conduct direct numerical simulations to investigate the synchronisation of Kolmogorov flows in a periodic box, with a focus on the mechanisms underlying the asymptotic evolution of infinitesimal velocity perturbations, also known as conditional leading Lyapunov vectors. This study advances previous work with a spectral analysis of the perturbation, which clarifies the behaviours of the production and dissipation spectra at different coupling wavenumbers. We show that, in simulations with moderate Reynolds numbers, the conditional leading Lyapunov exponent can be smaller than a lower bound proposed previously based on a viscous estimate. A quantitative analysis of the self-similar evolution of the perturbation energy spectrum is presented, extending the existing qualitative discussion. The prerequisites for obtaining self-similar solutions are established, which include an interesting relationship between the integral length scale of the perturbation velocity and the local Lyapunov exponent. By examining the governing equation for the dissipation rate of the velocity perturbation, we reveal the previously neglected roles of the strain rate and vorticity perturbations, and uncover their unique geometrical characteristics.
We presented an attosecond-precision timing detector based on linear optics. The minimum measurement floor is 1×10–10 fs2/Hz with only 1 mW input optical power. With this novel technique, the residual dispersion of a 5.2 km fiber link is characterized and precisely compensated. Finally, a comprehensive feedback model has been developed to analyze the noise coupling in a long-distance link stabilization system. The simulation results demonstrate an out-of-loop jitter of merely 359 as, integrated at [1 Hz, 1 MHz], at 1 mW input power per photodetector of our timing detector. Remarkably, the system is capable of maintaining sub-femtosecond precision even at optical power levels as low as 240 nW (for a 5.2 km link length), or link lengths as long as 20 km (with 1 μW optical power), respectively.
An important parameter characterising the synchronisation of turbulent flows is the threshold coupling wavenumber. This study investigates the relationship between the threshold coupling wavenumber and the leading Lyapunov vector using large eddy simulations and the SABRA model. Various subgrid-scale stress models, Reynolds numbers and different coupling methods are examined. A new scaling relation is identified for the leading Lyapunov exponents in large eddy simulations, showing that they approximate those of filtered direct numerical simulations. This interpretation provides a physical basis for results related to the Lyapunov exponents of large eddy simulations, including those related to synchronisation. Synchronisation experiments show that the peak wavenumber of the energy spectrum of the leading Lyapunov vector coincides with the threshold coupling wavenumber, in large eddy simulations of box turbulence with standard Smagorinsky or dynamic mixed models as well as in the SABRA model, replicating results from direct numerical simulations of box turbulence. Although the dynamic Smagorinsky model exhibits different behaviour, the totality of the results suggests that the relationship is an intrinsic property of a certain class of chaotic systems. We also confirm that conditional Lyapunov exponents characterise the synchronisation process in indirectly coupled systems as they do in directly coupled ones, with their values insensitive to the nature of the master flow. These findings advance the understanding of the role of the Lyapunov vector in the synchronisation of turbulence.
Recent studies have increasingly utilized gradient metrics to investigate the spatial transitions of brain organization, enabling the conversion of macroscale brain features into low-dimensional manifold representations. However, it remains unclear whether alterations exist in the cortical morphometric similarity (MS) network gradient in patients with schizophrenia (SCZ). This study aims to examine potential differences in the principal MS gradient between individuals with SCZ and healthy controls and to explore how these differences relate to transcriptional profiles and clinical phenomenology.
Methods
MS network was constructed in this study, and its gradient of the network was computed in 203 patients with SCZ and 201 healthy controls, who shared the same demographics in terms of age and gender. To examine irregularities in the MS network gradient, between-group comparisons were carried out, and partial least squares regression analysis was used to study the relationships between the MS network gradient-based variations in SCZ, and gene expression patterns and clinical phenotype.
Results
In contrast to healthy controls, the principal MS gradient of patients with SCZ was primarily significantly lower in sensorimotor areas, and higher in more areas. In addition, the aberrant gradient pattern was spatially linked with the genes enriched for neurobiologically significant pathways and preferential expression in various brain regions and cortical layers. Furthermore, there were strong positive connections between the principal MS gradient and the symptomatologic score in SCZ.
Conclusions
These findings showed changes in the principal MS network gradient in SCZ and offered potential molecular explanations for the structural changes underpinning SCZ.