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Despite growing healthcare coverage, disparities in access to and outcomes of psychiatric care persist, even in countries with universal healthcare. How socioeconomic status (SES), travel time, and social support individually and jointly affect psychiatric clinical trajectories remains largely unexplored.
Methods
We analyze electronic health records (EHRs) from patients diagnosed with bipolar disorder, major depressive disorder, or schizophrenia at Clínica San Juan de Dios Manizales. Using zero-inflated and standard negative binomial regression, we quantify the effects of SES, travel time, and family/social support on utilization, clinical outcomes, and symptoms of mania, psychosis, and suicidality. A mixed-effects model examines how care-seeking patterns affect visit-to-visit variability in outcomes.
Results
Among 21,095 patients, utilization is lower for those with low SES (rate ratio [RR] 0.92, 95% CI: 0.90–0.95, p = 1.27e−10) and longer travel times (RR 0.94, 95% CI: 0.93–0.95, p = 1.19e−53). Patients with low SES are more likely to have severe symptoms (e.g., delusions: RR 1.28, 95% CI: 1.20–1.37, p = 2.57e−15) and require hospitalization (RR 1.10, 95% CI: 1.05–1.15, p = 1.94e−04), suggesting they primarily seek care when critical. Longer travel differentially affects those with low SES. However, the relationship between SES and adverse outcomes is less pronounced when living with family (e.g., hospitalizations: LRT, χ2 = 47.08, df = 3, p = 3.35e−10). Frequent outpatient care is associated with lower odds of hospitalization, suicidality, and other symptoms.
Conclusions
Findings demonstrate use of EHRs to model patient outcomes, the important role of social support, and need for improved healthcare accessibility.
Although exposure and response prevention (EX/RP) is recommended as a first-line treatment for obsessive-compulsive disorder (OCD), responses vary among patients. This study was the first to use network analysis to examine how OCD symptom networks change with EX/RP and vary across different progress trajectories.
Methods
Data from four clinical trials with 334 adults with OCD who received manualized EX/RP were pooled. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was administered at baseline, midpoint, and post-treatment. OCD symptom networks were constructed using individual Y-BOCS items at these three time points, both for the entire sample and for three different progress trajectories (dramatic, moderate, and little-to-no progress) previously identified using growth mixture modeling. Network measures, including global efficiency, modularity, and weighted degree centrality, were computed to quantitatively assess network properties across treatment.
Results
Network analysis revealed two distinct modules at baseline: resistance/control and interference/distress. In the full sample, these two modules became integrated over time, as indicated by significant increases in global efficiency and weighted degree centrality and decreases in modularity; at post-treatment, the network shifted toward a fully connected network, and the strength of associations between nodes increased. These changes were most pronounced in the dramatic progress class.
Conclusions
Our findings indicated that effective EX/RP treatment was associated with more integrated OCD symptom networks, which may serve as an indicator of treatment response. Future research should examine how these shifts in network connectivity correspond to changes in underlying brain circuitry and/or to early identification of treatment responders.
Turbulence accounts for most of the energy losses associated with the pumping of fluids in pipes. Pulsatile drivings can reduce the drag and energy consumption required to supply a desired mass flux, when compared with steady driving. However, not all pulsation waveforms yield reductions. Here, we compute drag- and energy-optimal driving waveforms using direct numerical simulations and a gradient-free black-box optimisation framework. Specifically, we show that Bayesian optimisation is vastly superior to ordinary gradient-based methods in terms of computational efficiency and robustness, due to its ability to deal with noisy objective functions, as they naturally arise from the finite-time averaging of turbulent flows. We identify optimal waveforms for three Reynolds numbers and two Womersley numbers. At a Reynolds number of $8600$ and a Womersley number of 10, optimal waveforms reduce total energy consumption by 22 % and drag by 37 %. These reductions are rooted in the suppression of turbulence prior to the acceleration phase, the resulting delay in turbulence onset, and the radial localisation of turbulent kinetic energy and production towards the pipe centre. Our results pinpoint that the predominant, steady operation mode of pumping fluids through pipes is far from optimal.
With the introduction of tetflupyrolimet as the first herbicide with a novel site of action in the last three decades, screening for herbicide resistance before commercialization has become integral to ensure successful applications. In the mid-southern United States, tetflupyrolimet is anticipated to be used as a preemergence (PRE) herbicide for barnyardgrass control but does exhibit postemergence (POST) herbicidal activity. In 2020, 45 Echinochloa crus-galli (barnyardgrass) accessions were collected from rice-producing areas in Arkansas and were screened in the greenhouse to tetflupyrolimet at 134 g ai ha-1 PRE and POST at the 2- to 3-leaf growth stage on a silt loam soil. A field experiment was conducted where tetflupyrolimet was applied alone at 134 g ai ha-1 or with clomazone at 336 g ai ha-1, to a susceptible barnyardgrass standard and four other accessions with confirmed resistance to florpyrauxifen-benzyl, imazethapyr, propanil, and quinclorac at the spiking, 1-, 2-, 3-, and 4-leaf stages. For the PRE screening, the percent visible control ranged from 88% to 99%, with some accessions differing in sensitivity to tetflupyrolimet. Percent mortality ranged from 47% to 90% at the PRE timing. Visible control and mortality ranged from 63% to 88% and 7% to 65%, respectively, from a POST application, suggesting there is differential sensitivity and that foliar applications may not be as effective as soil applications. In the field experiment, barnyardgrass accession did not influence POST biomass production and was impacted more by the growth stage at application, although the difference was frequently numerical. In general, applying tetflupyrolimet alone or with clomazone to ≥3 leaf grass compromised performance. Tetflupyrolimet will be better optimized as a soil-applied herbicide in mid-southern U.S. rice culture.
Extreme precipitation events are projected to increase both in frequency and intensity due to climate change. High-resolution climate projections are essential to effectively model the convective phenomena responsible for severe precipitation and to plan any adaptation and mitigation action. Existing numerical methods struggle with either insufficient accuracy in capturing the evolution of convective dynamical systems, due to the low resolution, or are limited by the excessive computational demands required to achieve kilometre-scale resolution. To fill this gap, we propose a novel deep learning regional climate model (RCM) emulator called graph neural networks for climate downscaling (GNN4CD) to estimate high-resolution precipitation. The emulator is innovative in architecture and training strategy, using graph neural networks (GNNs) to learn the downscaling function through a novel hybrid imperfect framework. GNN4CD is initially trained to perform reanalysis to observation downscaling and then used for RCM emulation during the inference phase. The emulator is able to estimate precipitation at very high resolution both in space ($ 3 $km) and time ($ 1 $h), starting from lower-resolution atmospheric data ($ \sim 25 $km). Leveraging the flexibility of GNNs, we tested its spatial transferability in regions unseen during training. The model trained on northern Italy effectively reproduces the precipitation distribution, seasonal diurnal cycles, and spatial patterns of extreme percentiles across all of Italy. When used as an RCM emulator for the historical, mid-century, and end-of-century time slices, GNN4CD shows the remarkable ability to capture the shifts in precipitation distribution, especially in the tail, where changes are most pronounced.
Sitodiplosis mosellana (Géhin) (Diptera: Cecidomyiidae) is a significant pest of wheat, Triticum aestivum Linnaeus (Poaceae), in Canada. Monitoring currently relies on labour-intensive counts of ovipositing females. Although traps baited with S. mosellana pheromone are used as decision support tools in the United Kingdom, in Canada, they are considered reliable only to indicate adult activity. Recent findings show that variability in pheromone release from commercial lures affects the number of midges captured and limits the reliability of pheromone monitoring. Here, two lure types and two trap types were compared for their ability to attract and retain S. mosellana males. We then compared the number of males captured in pheromone traps with the information provided by other monitoring tools, including emergence traps, soil cores, and ovipositing female counts. Jackson traps with Trécé rubber septa lures captured the most midges. The number of males captured in pheromone-baited traps was not related to overwintering, ovipositing, or emerging populations, suggesting that pheromone traps may not accurately reflect S. mosellana populations under field conditions. Variability in extracted pheromone amount between lures, regional climate, and Canada’s vast wheat-growing area may limit the development of an effective pheromone-based decision support tool for this region. Nevertheless, refinement of lure formulation, standardisation of trapping protocols, and integration of complementary monitoring approaches may enhance trap reliability and support a stronger monitoring system.
Historically US-based academic organizations dedicated limited resources, including policies, personnel to ensuring compliance with clinical trials registration and results reporting requirements. A recent follow-up survey finds that 6-years after an initial survey, there is increased attention and dedication of resources to improve compliance rates for clinical trials registration and results reporting.
Methods:
Internet-based online survey using Qualtrics between 20 April 2023 and 30 September 2023 distributed to Protocol Registration and Results Reporting (PRS) Administrators at US-based academic organizations with ClinicalTrials.gov organizational accounts. The survey focused on the 249 respondents of the original 2016–2017 survey published in 2018. The overall response rate was 162/249 (65.06%) with 100% participation from National Cancer Center (NCI) Designated Cancer Centers and hubs of the Clinical and Translational Science Awards (CTSA).
Results:
Results indicated a marked increase of academic organizations with policies in place for registration (43 to 74%) and results reporting (35 to 68%). The median number of Full-time Equivalent (FTE) staff at responding academic organizations increased (from 0.08 to 0.5) with statistically significant difference between the number of organizational records and FTEs supporting registration and results reporting. Larger gains are seen with NCI-Designated Cancer Centers and/or CTSA hubs.
Conclusions:
It appears academic organizations are more equipped to comply with requirements, and demonstrate a trend towards appropriate staffing. In the 6 years since the original survey, US-based academic organizations have significantly increased attention to compliance with clinical trials registration and results reporting requirements, indicated by an increase in institutional policies and dedicated personnel.
Histidine is an essential limiting amino acid in piglet diets and plays a crucial role in pig production. Supplementing piglet diets with adequate histidine can enhance growth performance, promote protein synthesis, regulate lipid metabolism, and improve immune function in piglets. A large body of evidence indicates that histidine may improve digestion, nutrient absorption, and intestinal microbiota balance, thereby enhancing intestinal health. This review covers histidine’s physicochemical properties, metabolic pathways, its application in piglet diets, and the requirements and influencing factors of histidine in piglets. The aim is to provide a reference for the precise use of histidine in piglet production.
This study explores the development and scale-up of an emerging carbon capture technology using molten carbonate electrolysis, which converts CO2 into high-value graphene nanocarbons (GNCs) and oxygen in a single step, offering a scalable and economically incentivized pathway to address global greenhouse gas emissions. Paths to large-scale carbon capture using molten carbonate electrolysis that splits CO2 into GNCs and O2 are studied and advanced. GNCs include carbon nanotubes, carbon nano-onions and other zero-, one-, two- and three-dimensional graphene nanoallotropes. The CO2 to carbon nanotechnology (C2CNT) carbon capture utilization process directly removes the greenhouse gas CO2 over a wide range of concentrations (from 400 ppm to pure CO2), incentivizing the capture by providing a value-added product. Scale-up of the original lab-scale discovery of the transition metal nucleated electrolytic splitting of CO2 to an industrial process is documented. The scale-up includes a three-order-of-magnitude increase in the size of the electrolysis electrodes, an increase in the individual electrolysis modules to 100-tonne CO2 annually, and a new industrial-scale production extraction unit separating the molten electrolyte from the GNC product. The molten carbonate electrolyte has evolved from costly pure lithium carbonate to multicomponent carbonate electrolytes, predominantly based on 10-fold less expensive strontium carbonate. Other advances include the introduction of a new direct cathode press for separation and extraction of the GNC product, as well as specialized modifications of C2CNT for carbon capture, utilization and storage of industrial processes (Genesis CCUS), direct air capture (Genesis DAC) and the separate recovery of the oxygen product (Genesis O2).
While scholars of deliberative democracy have long conceded that good deliberation requires careful facilitation, little attention has been paid to the effects of different facilitation methods. This paper has three aims. First, it establishes the importance of facilitation. Second, it argues that facilitation may not be enough to counteract the imbalances in power and influence within deliberation. As such, this paper introduces two games that can be utilized in concert with facilitation: deliberative worth exercises and simulated representation. The former pushes participants to remain aware of their behavior patterns within deliberation by asking them to choose the best deliberator at the end of each round of deliberation; the latter enables empathy and perspective-taking by partnering participants and asking them to represent one another’s viewpoints for a portion of deliberation as if they were their own. Third, using proof-of-concept experiments, this paper demonstrates the efficacy of these games.
Pelmatozoa is an informal grouping of filter-feeding echinoderms including crinoids, paracrinoids, rhombiferans, and eocrinoids that possess a theca, an erect stalk, and feeding appendages. Although crinoids were major constituents of marine communities with high diversity and abundance throughout the Paleozoic, most other pelmatozoans had relatively low species diversity and/or short temporal durations. It has been proposed that these different diversification trajectories could have resulted from crinoids outcompeting other filter-feeding pelmatozoans during the early Paleozoic, although this hypothesis involving niche overlap has never been formally tested. Here, we tested this hypothesis using the incredibly diverse pelmatozoan fauna of the Late Ordovician (Sandbian) Bromide Formation of Oklahoma, which preserves a rich, ecologically complex fauna that developed as a result of the Great Ordovician Biodiversification Event. We developed a framework to quantitatively characterize pelmatozoan feeding ecology using multivariate analysis of ecomorphological traits and explored niche space occupation and potential competition between crinoids, rhombiferans, paracrinoids, eocrinoids, and diploporans from the Bromide fauna. Results revealed key ecological factors controlling niche differentiation and showed that crinoids, paracrinoids, and rhombiferans occupy nonoverlapping regions of niche space, indicating competition between groups was unlikely. Although the competition hypothesis was not supported, narrow niche space occupation suggests that paracrinoids and rhombiferans were more ecologically limited than crinoids, which might have played a role in their differential diversification dynamics. These results elucidate both the nature of interactions between pelmatozoan taxa and the potential mechanisms driving their evolutionary trajectories, as well as the complexity of ecological communities that arose during the Ordovician radiation.
Pulsar timing arrays (PTAs) are Galactic-scale nanohertz-frequency gravitational wave (GW) detectors. Recently, several PTAs have found evidence for the presence of GWs in their datasets, but none of them have achieved a community-defined definitive ($\gt 5\sigma$) detection. Here, we identify limiting noise sources for PTAs and quantify their impact on sensitivity to GWs under different observing and noise modelling strategies. First, we search for intrinsic pulse jitter in a sample of 89 millisecond pulsars (MSPs) observed by the MeerKAT Pulsar Timing Array (MPTA) and obtain new jitter measurements for 20 MSPs. We then forecast jitter noise in pulsars for the future SKA-Mid telescope, finding that the timing precision of many of the best-timed MSPs would be dominated by jitter noise. We then consider dispersion measure variations from the interstellar medium and find that their effects are best mitigated by modelling them as a stationary Gaussian process with a power law spectrum. Improving upon the established hasasia code for PTA sensitivity analysis, we assess the timing potential of the lower frequency UHF-band (544$-$1088 MHz) of MeerKAT and find a potential increase in GW background sensitivity by $\approx 8$%, relative to observing at L-band. We show that this improvement relies on assumptions on the propagation through the interstellar medium and highlight that if observing frequency-dependent propagation effects, such as scattering noise, are present, where noise is not completely correlated across observing frequency, then the improvement is significantly diminished. Using the multi-frequency receivers and sub-arraying flexibility of MeerKAT, we find that focused, high-cadence observations of the best MSPs can enhance the sensitivity of the array for both the continuous GWs and stochastic GW background. These results highlight the role of MeerKAT and the MPTA in the context of international GW search efforts.
Structural imaging studies of borderline personality disorder (BPD) have identified regions of reduced and increased cortical volume, as well as volume reductions in the hippocampus and amygdala, although with considerable variability across studies. Examining adolescent patients with the disorder can reduce potential confounding effects such as later development of affective and other comorbid disorders.
Methods
Fifty-one adolescents (48 females, 3 males) with BPD and without comorbid disorders and with 43 matched healthy controls underwent whole-brain voxel-based morphometry (VBM). Hippocampus and amygdala volumes were also measured using conventional volumetric techniques.
Results
At a threshold of p = 0.05 corrected, the BPD patients exhibited a cluster of grey matter volume reduction in the left temporo-parietal junction (TPJ). No evidence of volume reductions in the hippocampus or amygdala was found. Comparison between the female-only subsamples (48 BPD patients and 37 controls) yielded similar findings. The cluster of volume reduction in the left TPJ continued to be seen in 37 drug-naïve patients.
Conclusions
According to this study, the initial stage of BPD is characterized by decreased grey matter volume in the left TPJ, a region that is implicated in various aspects of social cognition. Given that the volume loss was detected prior to adulthood, in individuals without comorbidities, and among patients who were drug naïve, this finding could be significant for understanding the developmental trajectory of the disease.
A seminal result of Komlós, Sárközy, and Szemerédi states that any $n$-vertex graph $G$ with minimum degree at least $(1/2+\alpha )n$ contains every $n$-vertex tree $T$ of bounded degree. Recently, Pham, Sah, Sawhney, and Simkin extended this result to show that such graphs $G$ in fact support an optimally spread distribution on copies of a given $T$, which implies, using the recent breakthroughs on the Kahn-Kalai conjecture, the robustness result that $T$ is a subgraph of sparse random subgraphs of $G$ as well. Pham, Sah, Sawhney, and Simkin construct their optimally spread distribution by following closely the original proof of the Komlós-Sárközy-Szemerédi theorem which uses the blow-up lemma and the Szemerédi regularity lemma. We give an alternative, regularity-free construction that instead uses the Komlós-Sárközy-Szemerédi theorem (which has a regularity-free proof due to Kathapurkar and Montgomery) as a black box. Our proof is based on the simple and general insight that, if $G$ has linear minimum degree, almost all constant-sized subgraphs of $G$ inherit the same minimum degree condition that $G$ has.
In a retrospective cohort of 6363 neonates admitted to three NICUs, there was no reduction in Staphylococcus aureus acquisition when comparing pre- and post-pandemic incidence rates. While additional infection prevention practices introduced during the pandemic helped prevent SARS-CoV-2 transmission, these practices may not have reduced S. aureus transmission to infants.
We explore how honesty-humility and the other HEXACO personality traits relate to citizens’ nascent ambition and their recruitment to run for office. We extend previous work on virtue-related personality traits and political recruitment in two important ways: we go beyond North America and conduct a five-country cross-national study with nationally representative samples. More importantly, going beyond individual-level differences in nascent ambition, we also address how honesty-humility predicts the likelihood of being asked to and actually running for office. Based on data from Canada, Denmark, Israel, the Netherlands, and Switzerland, we demonstrate that citizens with lower levels of honesty-humility are more likely to have considered running, to deem themselves qualified to run, to have been asked to run, and to actually have run for a political office. From a ‘virtue ethics’ perspective, this is highly concerning: low honesty-humility predisposes individuals to engage in unethical behavior and decision-making. We discuss implications for the quality of political representation.
We analyze the extent to which the prospects for economic development may relate to the environmental damages associated with economic activities. We consider an economic growth framework in which production activities generate polluting emissions which in turn negatively affect production capabilities, and publicly-funded abatement is pursued to mitigate such effects. Since the time preference is endogenously related to capital, abatement affects the size of the discount factor through its implications on capital accumulation. We show that the elasticity of environmental damages affects the optimal tax rate and thus the abatement level, which in turn determines whether the economy will end up in a stagnation or growth regime. This suggests that the cross-country heterogeneity in environmental damages may explain the different development patterns experienced by industrialized and developing economies. Our results are robust to the presence of productive public spending and two alternative forms of capital (clean and dirty capital).
This paper presents a novel robust control method for a hip-assist exoskeleton robot’s joint module, addressing dynamic performance under variable loads. The proposed approach integrates traditional PID control with robust, model-based strategies, utilizing the system’s dynamic model and a Lyapunov-based robust controller to handle uncertainties. This method not only enhances traditional PID control but also offers practical advantages in implementation. Theoretical analysis confirms the system’s uniform boundedness and ultimate boundedness. A Matlab prototype was developed for simulation, demonstrating the control scheme’s feasibility and effectiveness. Numerical simulations show that the proposed fractional-order hybrid PD (FHPD) controller significantly reduces tracking error by 58.70% compared to the traditional PID controller, 55.41% compared to the MPD controller, and 32.32% compared to ADRC, highlighting its superior tracking performance and stability.