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Identifying patients with first-episode psychosis (FEP) who are unlikely to achieve early clinical recovery (ECR) is critical for personalised intervention and resource allocation. ECR – defined as the concurrent achievement of symptomatic and functional remission – represents a clinically meaningful outcome that captures both illness control and functional reintegration.
Aims
To develop and externally validate prediction models for ECR using clinical, cognitive and genetic data.
Method
We analysed two large, independent Spanish cohorts: the primeros episodios psicóticos cohort (N = 335), for model development and internal validation, and the Programa Asistencial a las Fases Iniciales de Psicosis cohort (N = 668), for external validation. Forty-seven baseline clinical and cognitive variables and 87 polygenic risk scores (PRSs) were examined. Predictors were selected using penalised logistic regression. Logistic regression and three machine learning algorithms were compared for discrimination, calibration and clinical utility.
Results
The best-performing model was a logistic regression using six routinely collected clinical and cognitive predictors (duration of untreated psychosis, days of treated psychosis, baseline functioning, insight, executive function and cognitive reserve), with an optimism-corrected area under the receiver operating characteristic curve of 0.73 in development and 0.63 in external validation. PRS models showed limited external generalisability and did not improve prediction. Machine learning algorithms offered no advantage over regression models.
Conclusions
A simple, interpretable logistic regression model based on routine clinical and cognitive variables can predict early recovery in FEP with acceptable generalisability. These findings support the use of transparent, clinically grounded models in early psychosis care and highlight the current limitations of genetic predictors for individualised treatment.
The Epilogue provides a reflective distillation of the book’s major claims and anticipatory warnings. It revisits the central idea that the human species is entering a new epoch of cognitive modulation — one that combines the ancient allure of psychoactive substances with the unprecedented reach of digital simulation. It affirms that while such tools offer extraordinary opportunities for creativity, healing, and connection, they also pose significant risks to autonomy, mental integrity, and collective meaning-making. The epilogue emphasises the urgency of ethical design, regulatory foresight, and public education to manage this dual-edged transformation. It concludes with a speculative yet grounded vision: that the next phase of human evolution may depend less on biology and more on how we symbolically navigate our internal and external realities. The final call is for conscious engagement — with our histories, technologies, and altered states — to ensure our adaptations remain humane and meaningful.
This integrative chapter highlights the interdisciplinary implications of the book’s core arguments. It synthesises the historical, neuroscientific, cultural, and ethical perspectives covered in earlier chapters, showing how they converge around a central theme: the human impulse to reshape consciousness through external means. The summary identifies key throughlines such as the neurochemical basis of thrill-seeking, the symbolic encoding of drug use, the commodification of altered states, and the rise of digital simulation as a new frontier of mind alteration. It stresses the importance of cross-disciplinary collaboration in addressing emerging challenges — including addiction, mental health, identity fragmentation, and regulatory vacuums. The chapter proposes that future research and policy must account for the hybrid nature of cognitive environments, shaped by both chemical inputs and algorithmic systems. Ultimately, it reaffirms the need to develop new cultural literacies and ethical frameworks suited to the complexities of the digital-chemical age.
Malaria, historically a significant health burden in temperate Europe, particularly in the low-lying marshy areas, is often poorly represented in discussions of health in the pre-modern Netherlands. Although malaria does not produce pathognomonic skeletal lesions, the haemolytic anaemia associated with repeated infection is thought to contribute to the development of cribra orbitalia, making population-level patterns in this non-specific skeletal marker informative for exploring past malaria burden. This study applied a spatial epidemiological approach, which investigated (1) the spatial distribution of cribra orbitalia prevalence across 28 archaeological medieval sites in the Netherlands, and (2) whether this distribution can be explained by underlying environmental features consistent with malaria transmission and historical mosquito density. Global Moran’s I revealed a significant positive spatial autocorrelation in prevalence. Local Indicator of Spatial Association (LISA) analysis confirmed this, identifying distinct High–High clusters in the Southwest and Low–Low clusters in the East of the Netherlands. However, linear regression models using broad-scale environmental variables failed to explain these spatial patterns. This likely reflects their inability to capture the specific ecology of the local malaria mosquito, Anopheles atroparvus, which preferentially breeds in brackish environments. Consistent with this interpretation, cribra orbitalia prevalence was significantly positively correlated with historical (1938) estimates of A. atroparvus density. The observed clustering and correlation with mosquito density suggest that malaria contributed to cribra orbitalia prevalence and may have been an important disease in certain regions of the medieval Netherlands; however, interpretation is constrained by small non-adult sample sizes as well as uneven preservation across the Netherlands.
Adolescence marks a critical period for the onset of anxiety disorders, yet they frequently remain undiagnosed due to barriers such as reluctance to self-disclose symptoms. Objective screening methods that bypass self-report may improve early detection. Speech-derived acoustic markers have emerged as a promising avenue for identifying anxiety disorders. This study investigates associations between acoustic properties of speech, anxiety severity, and anxiety diagnoses in adolescents, evaluated cross-sectionally and longitudinally.
Methods
Speech samples from 581 adolescents were collected during the Trier Social Stress Test. Acoustic features were extracted using OpenSMILE and analyzed for cross-sectional associations with anxiety severity (Spearman’s correlations) and longitudinal predictions of future anxiety (linear regressions). Random forest (RF) classifiers with 10-fold cross-validation were used to classify anxious and healthy individuals using acoustic features. Analyses were stratified by sex.
Results
RFs achieved the highest performance for the longitudinal classification of social anxiety disorder (SAD), with an AUC-ROC of 85% (males) and 74% (females). Adding acoustic features to baseline measures increased the variance explained in anxiety by 5.4% (males) and 10.9% (females). In males, higher anxiety was cross-sectionally correlated with reduced pitch slope, narrower pitch range, lower F1 frequency, and greater MFCC1 variability. Females with higher anxiety showed reduced variability in pitch slope. Correlations did not survive multiple testing correction.
Conclusions
Acoustic speech markers elicited in socially evaluative contexts can accurately recognize SAD in male adolescents three years in advance. Performance is moderate for females and other anxiety disorders, underscoring the need for sex-specific approaches to diagnostic tool development.
Depressive symptoms are highly prevalent in first-episode psychosis (FEP) and worsen clinical outcomes. It is currently difficult to determine which patients will have persistent depressive symptoms based on a clinical assessment. We aimed to determine whether depressive symptoms and post-psychotic depressive episodes can be predicted from baseline clinical data, quality of life, and blood-based biomarkers, and to assess the geographical generalizability of these models.
Methods
Two FEP trials were analyzed: European First-Episode Schizophrenia Trial (EUFEST) (n = 498; 2002–2006) and Recovery After an Initial Schizophrenia Episode Early Treatment Program (RAISE-ETP) (n = 404; 2010–2012). Participants included those aged 15–40 years, meeting Diagnostic and Statistical Manual of Mental Disorders IV criteria for schizophrenia spectrum disorders. We developed support vector regressors and classifiers to predict changes in depressive symptoms at 6 and 12 months and depressive episodes within the first 6 months. These models were trained in one sample and externally validated in another for geographical generalizability.
Results
A total of 320 EUFEST and 234 RAISE-ETP participants were included (mean [SD] age: 25.93 [5.60] years, 56.56% male; 23.90 [5.27] years, 73.50% male). Models predicted changes in depressive symptoms at 6 months with balanced accuracy (BAC) of 66.26% (RAISE-ETP) and 75.09% (EUFEST), and at 12 months with BAC of 67.88% (RAISE-ETP) and 77.61% (EUFEST). Depressive episodes were predicted with BAC of 66.67% (RAISE-ETP) and 69.01% (EUFEST), showing fair external predictive performance.
Conclusions
Predictive models using clinical data, quality of life, and biomarkers accurately forecast depressive events in FEP, demonstrating generalization across populations.
Coronaviruses of the human variety have been the culprit of global epidemics of varying levels of lethality, including COVID-19, which has impacted more than 200 countries and resulted in 5.7 million fatalities as of May 2022. Effective clinical management necessitates the allocation of sufficient resources and the employment of appropriately skilled personnel. The elderly population and individuals with diabetes are at increased risk of more severe manifestations of COVID-19. Countries with a higher gross domestic product (GDP) typically exhibit superior health outcomes and reduced mortality rates. Here, we suggest a predictive model for the density of medical doctors and nursing personnel for 134 countries using a support vector machine (SVM). The model was trained in 107 countries and tested in 27, with promising results shown by the kappa statistics and ROC analysis. The SVM model used for predictions showed promising results with a high level of agreement between actual and predicted cluster values.
This Research Communication explores the usefulness of predictive modelling to explain bacterial behaviour during cooling. A simple dynamic lag phase model was developed and validated. The model takes into account the effect of the cooling profile on the lag phase and growth in bulk tank milk. The time before the start of cooling was the most critical and should not exceed 1 h. The cooling rate between 30 and approximately 10 °C was the second most critical period. Cooling from 30 to 10 °C within 2 h ensured minimal growth of psychrotrophic bacteria in the milk. The cooling rate between 10 and 4 °C (the slowest phase of cooling) was of surprisingly little importance. Given a normal cooling profile to 10 °C, several hours of prolonged cooling time made practically no difference in psychrotrophic counts. This behaviour can be explained by the time/temperature dependence of the work needed by the bacteria to complete the lag phase at low temperature. For milk quality advisors, it is important to know that slow cooling below 10 °C does not result in high total counts of bacteria. In practice, slow cooling is occasionally found at farms with robotic milking. However, when comparing psychrotrophic growth in bulk milk tanks designed for robotic milking or conventional milking, the model predicted less growth for robotic milking for identical cooling profiles. It is proposed that due to the different rates of milk entering the tank, fewer bacteria will exit the lag phase during robotic milking and they will be more diluted than in conventional milking systems. At present, there is no international standard that specifies the cooling profile in robotic systems. The information on the insignificant effect of the cooling rate below 10 °C may be useful in the development of a standard.
For the first time, geomorphology and archaeology are combined for a 165 km long stretch of the Meuse river, resulting in a geomorphogenetic map (GKM) and a series of archaeological predictive maps (AVM). The maps cover the central part the Meuse valley, located in the province of Limburg between Mook in the north and Eijsden in the south. The area consists of fluvial and aeolian landforms of the Holocene Meuse floodplain and Younger Dryas aged terraces along it, spanning a period of approximately 15,000 years of landscape genesis and human habitation. The GKM more clearly discriminates between map units of Younger Dryas and early Holocene age than in previous mappings of the Meuse valley. The AVM series provide predictive information on the location of sites for four distinct consecutive archaeological periods and four main cultural themes. The maps contribute to a better understanding of landscape processes (fluvial and aeolian geomorphology and the impact of man on river behaviour), and the possibilities for human habitation and land use in prehistoric and historic times.
The aim of this study is to develop predictive models to predict organ at risk (OAR) complication level, classification of OAR dose-volume and combination of this function with our in-house developed treatment decision support system.
Materials and methods
We analysed the support vector machine and decision tree algorithm for predicting OAR complication level and toxicity in order to integrate this function into our in-house radiation treatment planning decision support system. A total of 12 TomoTherapyTM treatment plans for prostate cancer were established, and a hundred modelled plans were generated to analyse the toxicity prediction for bladder and rectum.
Results
The toxicity prediction algorithm analysis showed 91·0% accuracy in the training process. A scatter plot for bladder and rectum was obtained by 100 modelled plans and classification result derived. OAR complication level was analysed and risk factor for 25% bladder and 50% rectum was detected by decision tree. Therefore, it was shown that complication prediction of patients using big data-based clinical information is possible.
Conclusion
We verified the accuracy of the tested algorithm using prostate cancer cases. Side effects can be minimised by applying this predictive modelling algorithm with the planning decision support system for patient-specific radiotherapy planning.
Psychiatric research has entered the age of ‘Big Data’. Datasets now routinely involve thousands of heterogeneous variables, including clinical, neuroimaging, genomic, proteomic, transcriptomic and other ‘omic’ measures. The analysis of these datasets is challenging, especially when the number of measurements exceeds the number of individuals, and may be further complicated by missing data for some subjects and variables that are highly correlated. Statistical learning-based models are a natural extension of classical statistical approaches but provide more effective methods to analyse very large datasets. In addition, the predictive capability of such models promises to be useful in developing decision support systems. That is, methods that can be introduced to clinical settings and guide, for example, diagnosis classification or personalized treatment. In this review, we aim to outline the potential benefits of statistical learning methods in clinical research. We first introduce the concept of Big Data in different environments. We then describe how modern statistical learning models can be used in practice on Big Datasets to extract relevant information. Finally, we discuss the strengths of using statistical learning in psychiatric studies, from both research and practical clinical points of view.
Underwriting in the United States (US) life insurance marketplace has evolved tremendously over the last several decades. This paper will take a brief look at that history, from the older underwriting techniques still in use today to the introduction of smoker/nonsmoker distinctions in about 1980 to the evolution of preferred underwriting in the late 1980s, and finally to a movement toward simplified issue underwriting and a new approach to older age underwriting today.
The calculus of looping sequences is a formalism for describing theevolution of biological systems by means of term rewriting rules. Inthis paper we enrich this calculus with a type discipline whichpreserves some biological properties depending on the minimum andthe maximum number of elements of some type requested by the present elements. The typesystem enforces these properties and typed reductions guarantee thatevolution preserves them. As an example, we model the hemoglobinstructure and the equilibrium between cell death and division: typedreductions prevent undesirable behaviors.
Determining the effects of genetically modified (GM) crops on non-target organisms is essential as many non-target species provide important ecological functions. However, it is simply not possible to collect field data on more than a few potential non-target species present in the receiving environment of a GM crop. While risk assessment must be rigorous, new approaches are necessary to improve the efficiency of the process. Utilisation of published information and existing data on the phenology and population dynamics of test species in the field can be combined with limited amounts of experimental biosafety data to predict possible outcomes on species persistence. This paper presents an example of an approach where data from laboratory experiments and field studies on phenology are combined using predictive modelling. Using the New Zealand native weevil species Nicaeana cervina as a case study, we could predict that oviposition rates of the weevil feeding on a GM ryegrass could be reduced by up to 30% without threat to populations of the weevil in pastoral ecosystems. In addition, an experimentally established correlation between feeding level and oviposition led to the prediction that a consistent reduction in feeding of 50% or higher indicated a significant risk to the species and could potentially lead to local extinctions. This approach to biosafety risk assessment, maximising the use of pre-existing field and laboratory data on non-target species, can make an important contribution to informed decision-making by regulatory authorities and developers of new technologies.
Sparse grids are the basis for efficient high dimensional approximation and have recently been applied successfully to predictive modelling. They are spanned by a collection of simpler function spaces represented by regular grids. The sparse grid combination technique prescribes how approximations on a collection of anisotropic grids can be combined to approximate high dimensional functions.
In this paper we study the parallelisation of fitting data onto a sparse grid. The computation can be done entirely by fitting partial models on a collection of regular grids. This allows parallelism over the collection of grids. In addition, each of the partial grid fits can be parallelised as well, both in the assembly phase, where parallelism is done over the data, and in the solution stage using traditional parallel solvers for the resulting PDEs. Using a simple timing model we confirm that the most effective methods are obtained when both types of parallelism are used.
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