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Cyclic fluctuations in hypothalamic-pituitary-gonadal axis (HPG-axis) hormones exert powerful behavioral, structural, and functional effects through actions on the mammalian central nervous system. Yet, very little is known about how these fluctuations alter the structural nodes and information highways of the human brain. In a study of 30 naturally cycling women, we employed multidimensional diffusion and T1-weighted imaging during three estimated menstrual cycle phases (menses, ovulation, and mid-luteal) to investigate whether HPG-axis hormone concentrations co-fluctuate with alterations in white matter (WM) microstructure, cortical thickness (CT), and brain volume. Across the whole brain, 17β-estradiol and luteinizing hormone (LH) concentrations were directly proportional to diffusion anisotropy (μFA; 17β-estradiol: β1 = 0.145, highest density interval (HDI) = [0.211, 0.4]; LH: β1 = 0.111, HDI = [0.157, 0.364]), while follicle-stimulating hormone (FSH) was directly proportional to CT (β1 = 0 .162, HDI = [0.115, 0.678]). Within several individual regions, FSH and progesterone demonstrated opposing relationships with mean diffusivity (Diso) and CT. These regions mainly reside within the temporal and occipital lobes, with functional implications for the limbic and visual systems. Finally, progesterone was associated with increased tissue (β1 = 0.66, HDI = [0.607, 15.845]) and decreased cerebrospinal fluid (CSF; β1 = -0.749, HDI = [-11.604, -0.903]) volumes, with total brain volume remaining unchanged. These results are the first to report simultaneous brain-wide changes in human WM microstructure and CT coinciding with menstrual cycle-driven hormone rhythms. Effects were observed in both classically known HPG-axis receptor-dense regions (medial temporal lobe, prefrontal cortex) and in other regions located across frontal, occipital, temporal, and parietal lobes. Our results suggest that HPG-axis hormone fluctuations may have significant structural impacts across the entire brain.

BACKGROUND: The risk of recurrence is overestimated by the Kaplan-Meier method when competing events, such as death without recurrence, are present. Such overestimation can be avoided by using the Aalen-Johansen method, which is a direct extension of Kaplan-Meier that accounts for competing events. Meningiomas commonly occur in older individuals and have slow-growing properties, thereby warranting competing risk analysis. The extent to which competing events are considered in meningioma literature is unknown, and the consequences of using incorrect methodologies in meningioma recurrence risk analysis have not been investigated. METHODS: We surveyed articles indexed on PubMed since 2020 to assess the usage of competing risk analysis in recent meningioma literature. To compare recurrence risk estimates obtained through Kaplan-Meier and Aalen-Johansen methods, we applied our international database comprising ~ 8,000 patients with a primary meningioma collected from 42 institutions. RESULTS: Of 513 articles, 169 were eligible for full-text screening. There were 6,537 eligible cases from our PERNS database. The discrepancy between the results obtained by Kaplan-Meier and Aalen-Johansen was negligible among low-grade lesions and younger individuals. The discrepancy increased substantially in the patient groups associated with higher rates of competing events (older patients with high-grade lesions). CONCLUSION: The importance of considering competing events in recurrence risk analysis is poorly recognized as only 6% of the studies we surveyed employed Aalen-Johansen analyses. Consequently, most of the previous literature has overestimated the risk of recurrence. The overestimation was negligible for studies involving low-grade lesions in younger individuals; however, overestimation might have been substantial for studies on high-grade lesions.

Abstract The International Institute of Intellectual Cooperation (IIIC) was an international organisation established post-World War I, aimed to foster intellectual relations for global peace. As this institution becomes centenary, the digitisation of archival records has democratised access, sparking renewed scholar interest and eventually enabling new research avenues. Here, we examine two letter collections from IIIC’s digitised funds, focusing on administrative and artistic/literary matters. By analysing recognisable sender-receiver pairs and their geographical origins, we construct networks revealing intricate international relationships. Notably, the community structures and roles differ between administrative and literary exchanges, suggesting distinct communication dynamics. Administrative matters depict a more egalitarian distribution. In contrast, relevant literary correspondents include Western European countries exclusively, reflecting the prominence of certain geocultural areas as well as potential geopolitical influence attempts, challenging the established historical narratives on centres and peripheries, inviting a revaluation of the IIIC’s geographical organisation and intellectual cooperation during the interwar period.

Percutaneous Osseointegrated Implants (POI) affix artificial limbs to the body after amputation. Several adverse events challenge mainstream uptake of this technology. This study aims to achieve a consensus regarding “the challenges and adverse events to POI integration and long-term fixation in limb amputation”. We sought a panel of clinical experts divided by profession into surgical, clinical, or clinical academic categories. We used a real time eDelphi method to develop consensus on both the challenges and adverse event items, enabling anonymity, iteration, controlled feedback, and statistical aggregation of group responses. The full panel agreed that the most impactful items are amongst 10 key challenges and eight adverse events. Panellists were in consensus regarding the five most impactful challenges, which were, in decreasing order: patient selection, absence of a multidisciplinary team, design of the implant, soft tissue stability and an experienced surgical team. Panellists considered the five most impactful adverse events, in decreasing order, to be the following: no biological fixation, deep infection, aseptic loosening, no mechanical fixation, and implant breakage. Consensus was obtained on implant breakage and deep infection items. The proportion of consensus from the whole panel across all items was in line with the literature, and we observed an improvement in consensus once the panel was stratified based on job, expertise and implant system.

Abstract Background Polyploidisation often results in genome rearrangements that may involve changes in both the single-copy sequences and the repetitive genome fraction. In this study, we performed a comprehensive comparative analysis of repetitive DNA, with a particular focus on ribosomal DNA (rDNA), in Brachypodium hybridum (2n = 4x = 30, subgenome composition DDSS), an allotetraploid resulting from a natural cross between two diploid species that resemble the modern B. distachyon (2n = 10; DD) and B. stacei (2n = 20; SS). Taking advantage of the recurrent origin of B. hybridum, we investigated two genotypes, Bhyb26 and ABR113, differing markedly in their evolutionary age (1.4 and 0.14 Mya, respectively) and which resulted from opposite cross directions. To identify the origin of rDNA loci we employed cytogenetic and molecular methods (FISH, gCAPS and Southern hybridisation), phylogenetic and genomic approaches. Results Unlike the general maintenance of doubled gene dosage in B. hybridum, the rRNA genes showed a remarkable tendency towards diploidisation at both locus and unit levels. While the partial elimination of 35S rDNA units occurred in the younger ABR113 lineage, unidirectional elimination of the entire locus was observed in the older Bhyb26 lineage. Additionally, a novel 5S rDNA family was amplified in Bhyb26 replacing the parental units. The 35S and 5S rDNA units were preferentially eliminated from the S- and D-subgenome, respectively. Thus, in the more ancient B. hybridum lineage, Bhyb26, 5S and 35S rRNA genes are likely expressed from different subgenomes, highlighting the complexity of polyploid regulatory networks. Conclusion Comparative analyses between two B. hybridum lineages of distinct evolutionary ages revealed that although the recent lineage ABR113 exhibited an additive pattern of rDNA loci distribution, the ancient lineage Bhyb26 demonstrated a pronounced tendency toward diploidisation manifested by the reduction in the number of both 35S and 5S loci. In conclusion, the age of the allopolyploid appears to be a decisive factor in rDNA turnover in B. hybridum.

Abstract Understanding the mechanisms underlying a stable polarization at the surface of ferroelectric thin films is of particular importance both from a fundamental point of view and to achieve control of the surface polarization itself. In this study, we demonstrate that the X-ray standing wave technique allows the surface polarization profile of a ferroelectric thin film, as opposed to the average film polarity, to be probed directly. The X-ray standing wave technique provides the average Ti and Ba atomic positions, along the out-of-plane direction, near the surface of three differently strained $$\mathrm {BaTiO_3}$$ thin films. This technique gives direct access to the local ferroelectric polarization at and below the surface. By employing X-ray photoelectron spectroscopy, a detailed overview of the oxygen-containing species adsorbed on the surface is obtained. The different amplitude and orientation of the local ferroelectric polarizations are associated with surface charges attributed to different type, amount and spatial distribution of the oxygen-containing adsorbates.

Early-life stages play a key role in the dynamics of bipartite life cycle marine fish populations. Difficult to monitor, observations of these stages are often scattered in space and time. While Mediterranean coastlines have often been surveyed, no effort has been made to assemble historical observations. Here we build an exhaustive compilation of dispersal traits for coastal fish species, considering in situ observations and growth models (Di Stefano et al., 2023; https://doi.org/10.17882/91148). Our database contains over 110 000 entries collected from 1993 to 2021 in various subregions. All observations are harmonized to provide information on dates and geolocations of both spawning and settlement, along with pelagic larval durations. When applicable, missing data and associated confidence intervals are reconstructed from dynamic energy budget theory. Statistical analyses allow traits’ variability to be revisited and sampling biases to be revealed across taxa, space and time, hence providing recommendations for future studies and sampling. Comparison of observed and modelled entries provides suggestions to improve the feed of observations into models. Overall, this extensive database is a crucial step to investigate how marine fish populations respond to global changes across environmental gradients.

Abstract Background Opicapone is a third-generation catechol-O-methyl-transferase inhibitor currently used for the treatment of motor fluctuations in Parkinson’s disease. Its benefit and safety have been established by clinical trials; however, data about its use in a real-life context, and particularly in an Italian population of patients with Parkinson’s disease, are missing. Objectives We aimed to gather data about the real-life tolerability/safety of opicapone when used for the treatment of Parkinson’s disease-related motor fluctuations. Methods We enrolled 152 consecutive patients with Parkinson’s disease and followed them for 2 years after opicapone introduction. We obtained baseline clinical and demographical information, including disease duration, stage, phenotype, as well as axial and non-motor symptoms. We collected the reasons for any treatment interruption and adverse events emerging after opicapone introduction. Results Eighty-nine (58%) patients reported adverse events and 46 (30%) patients discontinued the treatment. Adverse events occurred less frequently in “earlier” patients accordingly to the disease course and l-Dopa treatment pathway; a motor fluctuation duration ≥12 months and Hoehn and Yahr scale score ≥2.5 were the main predictors of therapy withdrawal. Conclusions This study confirms the good tolerability/safety profile of opicapone in a real-life setting and provides country-specific data for Italian patients with Parkinson’s disease.

Abstract Background Systems that capture motion under laboratory conditions limit validity in real-world environments. Mobile motion capture solutions such as Inertial Measurement Units (IMUs) can progress our understanding of "real" human movement. IMU data must be validated in each application to interpret with clinical applicability; this is particularly true for diverse populations. Our IMU analysis method builds on the OpenSim IMU Inverse Kinematics toolkit integrating the Versatile Quaternion-based Filter and incorporates realistic constraints to the underlying biomechanical model. We validate our processing method against the reference standard optical motion capture in a case report with participants with transfemoral amputation fitted with a Percutaneous Osseointegrated Implant (POI) and without amputation walking over level ground. We hypothesis that by using this novel pipeline, we can validate IMU motion capture data, to a clinically acceptable degree. Results Average RMSE (across all joints) between the two systems from the participant with a unilateral transfemoral amputation (TFA) on the amputated and the intact sides were 2.35° (IQR = 1.45°) and 3.59° (IQR = 2.00°) respectively. Equivalent results in the non-amputated participant were 2.26° (IQR = 1.08°). Joint level average RMSE between the two systems from the TFA ranged from 1.66° to 3.82° and from 1.21° to 5.46° in the non-amputated participant. In plane average RMSE between the two systems from the TFA ranged from 2.17° (coronal) to 3.91° (sagittal) and from 1.96° (transverse) to 2.32° (sagittal) in the non-amputated participant. Coefficients of Multiple Correlation (CMC) results between the two systems in the TFA ranged from 0.74 to > 0.99 and from 0.72 to > 0.99 in the non-amputated participant and resulted in ‘excellent’ similarity in each data set average, in every plane and at all joint levels. Normalized RMSE between the two systems from the TFA ranged from 3.40% (knee level) to 54.54% (pelvis level) and from 2.18% to 36.01% in the non-amputated participant. Conclusions We offer a modular processing pipeline that enables the addition of extra layers, facilitates changes to the underlying biomechanical model, and can accept raw IMU data from any vendor. We successfully validate the pipeline using data, for the first time, from a TFA participant using a POI and have proved our hypothesis.

Abstract Eutrophication is a main threat to continental aquatic ecosystems. Prevention and amelioration actions have been taken under the assumption of a stable climate, which needs reconsideration. Here, we show that reduced precipitation can bring a lake ecosystem to a more productive regime even with a decline in nutrient external load. By analyzing time series of several decades in the largest lake of the Iberian Peninsula, we found autocorrelated changes in the variance of state variables (i.e., chlorophyll and oxygen) indicative of a transient situation towards a new ecosystem regime. Indeed, exceptional planktonic diatom blooms have occurred during the last few years, and the sediment record shows a shift in phytoplankton composition and an increase in nutrient retention. Reduced precipitation almost doubled the water residence time in the lake, enhancing the relevance of internal processes. This study demonstrates that ecological quality targets for aquatic ecosystems must be tailored to the changing climatic conditions for appropriate stewardship.

Abstract Artificial intelligence (AI) is revolutionizing the field of medical imaging, holding the potential to shift medicine from a reactive “sick-care” approach to a proactive focus on healthcare and prevention. The successful development of AI in this domain relies on access to large, comprehensive, and standardized real-world datasets that accurately represent diverse populations and diseases. However, images and data are sensitive, and as such, before using them in any way the data needs to be modified to protect the privacy of the patients. This paper explores the approaches in the domain of five EU projects working on the creation of ethically compliant and GDPR-regulated European medical imaging platforms, focused on cancer-related data. It presents the individual approaches to the de-identification of imaging data, and describes the problems and the solutions adopted in each case. Further, lessons learned are provided, enabling future projects to optimally handle the problem of data de-identification. Critical relevance statement This paper presents key approaches from five flagship EU projects for the de-identification of imaging and clinical data offering valuable insights and guidelines in the domain. Key Points ΑΙ models for health imaging require access to large amounts of data. Access to large imaging datasets requires an appropriate de-identification process. This paper provides de-identification guidelines from the AI for health imaging (AI4HI) projects.

Abstract Sensorimotor impairments, resulting from conditions like stroke and amputations, can profoundly impact an individual’s functional abilities and overall quality of life. Assistive and rehabilitation devices such as prostheses, exo-skeletons, and serious gaming in virtual environments can help to restore some degree of function and alleviate pain after sensorimotor impairments. Myoelectric pattern recognition (MPR) has gained popularity in the past decades as it provides superior control over said devices, and therefore efforts to facilitate and improve performance in MPR can result in better rehabilitation outcomes. One possibility to enhance MPR is to employ transcranial direct current stimulation (tDCS) to facilitate motor learning. Twelve healthy able-bodied individuals participated in this crossover study to determine the effect of tDCS on MPR performance. Baseline training was followed by two sessions of either sham or anodal tDCS using the dominant and non-dominant arms. Assignments were randomized, and the MPR task consisted of 11 different hand/wrist movements, including rest or no movement. Surface electrodes were used to record EMG and the MPR open-source platform, BioPatRec, was used for decoding motor volition in real-time. The motion test was used to evaluate performance. We hypothesized that using anodal tDCS to increase the excitability of the primary motor cortex associated with non-dominant side in able-bodied individuals, will improve motor learning and thus MPR performance. Overall, we found that tDCS enhanced MPR performance, particularly in the non-dominant side. We were able to reject the null hypothesis and improvements in the motion test’s completion rate during tDCS (28% change, p-value: 0.023) indicate its potential as an adjunctive tool to enhance MPR and motor learning. tDCS appears promising as a tool to enhance the learning phase of using assistive devices using MPR, such as myoelectric prostheses.

In this paper, we analyzed the local stability of three species in two fractional tritrophic systems, with Caputo's fractional derivative and Holling type Ⅱ and Ⅲ functional responses, when the prey density has a linear growth. To begin, we obtained the equilibria in the first octant under certain conditions for the parameters. Subsequently, through linearization and applying the Routh-Hurwitz Criterion, we concluded that only the system with Holling type Ⅲ exhibits an asymptotically stable equilibrium point, where the fractional derivative order belongs to the interval $ (0, 1] $. Finally, we obtained the solution of the system with the Holling type Ⅲ functional response, using the multistage homotopic perturbation method, and presented an example that shows the dynamics of the solutions around the stable equilibrium point.

Abstract The switching dynamics of antiferroelectric lead zirconate (PbZrO3) freestanding capacitors compared to their epitaxial counterparts is reported. Frequency dependence of hysteresis indicates that freestanding capacitors exhibit a lower dispersion of switching fields, lower residual polarization, and faster switching response as compared to epitaxially‐clamped capacitors. As a consequence, freestanding capacitor membranes exhibit better energy storage density and efficiency.

Introduction: This study aims to create an artificial intelligence (AI) based machine learning (ML) model capable of predicting a spirometric obstructive pattern using variables with the highest predictive power derived from an active case-finding program for COPD in primary care. Material and methods: A total of 1190 smokers, aged 30–80 years old with no prior history of respiratory disease, underwent spirometry with bronchodilation. The sample was analyzed using AI tools. Based on an exploratory data analysis (EDA), independent variables (according to mutual information analysis) were trained using a gradient boosting algorithm (GBT) and validated through cross-validation. Results: With an area under the curve close to unity, the model predicted a spirometric obstructive pattern using variables with the highest predictive power: FEV1_theoretical_pre values. Sensitivity: 93%. Positive predictive value: 94%. Specificity: 97%. Negative predictive value: 96%. Accuracy: 95%. Precision: 94%. Conclusion: An ML model can predict the presence of an obstructive pattern in spirometry in a primary care smoking population with no prior diagnosis of respiratory disease using the FEV1_theoretical_pre values with an accuracy and precision exceeding 90%. Further studies including clinical data and strategies for integrating AI into clinical workflow are needed. Resumen: Introducción: Este estudio tiene como objetivo crear un modelo de aprendizaje automático (ML) basado en inteligencia artificial (IA) capaz de predecir un patrón obstructivo espirométrico utilizando variables con el mayor poder predictivo derivado de un programa activo de búsqueda de casos de enfermedad pulmonar obstructiva crónica (EPOC) en Atención Primaria. Materiales y métodos: Un total de 1.190 fumadores, de entre 30 y 80 años, sin antecedentes de enfermedad respiratoria, fueron sometidos a espirometría con IA artificial. Sobre la base de un análisis de datos exploratorio (EDA), las variables independientes (según el análisis de información mutua) se entrenaron utilizando un algoritmo de gradiente de aumento (GBT) y se validaron mediante validación cruzada. Resultados: Con un área bajo la curva cercana a la unidad, el modelo predijo un patrón obstructivo espirométrico utilizando los valores del FEV1 prebroncodilatador. Sensibilidad: 93%. Valor predictivo positivo: 94%. Especificidad: 97%. Valor predictivo negativo: 96%. Precisión: 95%. Precisión: 94%. Conclusión: Un modelo ML puede predecir la presencia de un patrón obstructivo en la espirometría en una población fumadora de atención primaria sin diagnóstico previo de enfermedad respiratoria utilizando los valores FEV1 prebroncodilatadores con una exactitud y precisión superiores al 90%. Se necesitan más estudios que incluyan datos clínicos y estrategias para integrar la IA en el flujo de trabajo clínico.

BackgroundFNDs mimicking a stroke represent a growing challenge in the emergency department (ED). A comprehensive diagnostic approach involving clinical evaluation and neuroimaging is essential to differentiate stroke from mimics. The safety profile of thrombolysis justifies its use where FNDs cannot be ruled out. This approach highlights the need for more precise diagnostic tools and protocols to improve patient care and reduce unnecessary treatments. Distinguishing FNDs from actual cerebrovascular events is critical yet difficult, particularly under time constraints. Given the urgency and potential severity of strokes, intravenous thrombolysis is frequently administered even when FNDs cannot be definitively excluded.MethodsThis retrospective study analyzed data of participants admitted to the Trieste University Hospital Stroke Unit between January 2018 and December 2022, focusing on those presenting with sudden-onset focal neurological deficits mimicking a stroke, with some presenting within the reperfusion treatment window (

Despite the functional impact of cognitive deficit in people with psychosis, objective cognitive assessment is not typically part of routine clinical care. This is partly due to the length of traditional assessments and the need for a highly trained administrator. Brief, automated computerised assessments could help to address this issue. We present data from an evaluation of PsyCog, a computerised, non-verbal, mini battery of cognitive tests. Healthy Control (HC) (N = 135), Clinical High Risk (CHR) (N = 233), and First Episode Psychosis (FEP) (N = 301) participants from a multi-centre prospective study were assessed at baseline, 6 months, and 12 months. PsyCog was used to assess cognitive performance at baseline and at up to two follow-up timepoints. Mean total testing time was 35.95 min (SD = 2.87). Relative to HCs, effect sizes of performance impairments were medium to large in FEP patients (composite score G = 1.21, subtest range = 0.52–0.88) and small to medium in CHR patients (composite score G = 0.59, subtest range = 0.18–0.49). Site effects were minimal, and test-retest reliability of the PsyCog composite was good (ICC = 0.82–0.89), though some practice effects and differences in data completion between groups were found. The present implementation of PsyCog shows it to be a useful tool for assessing cognitive function in people with psychosis. Computerised cognitive assessments have the potential to facilitate the evaluation of cognition in psychosis in both research and in clinical care, though caution should still be taken in terms of implementation and study design.

Introduction: The concept of SBS as an occupational health problem is related to air pollution, inadequate ventilation, and indoor air quality in office buildings. Lighting in the RSUD Haji Building still does not meet general and local lighting standards. Complaints of eye fatigue are also felt by administrative staff in the outpatient room of the RSUD Haji Indonesia. This research aimed to examine how physical air quality and sick building syndrome give impact to officer productivity in the outpatient room of the RSUD Haji Indonesia. Methods: This kind of study used a cross-sectional design and was observational. Simple random sampling was utilized in the sampling process, and logistic and linear regression were used to analyze the data. Results and Discussion: Lighting in outpatient rooms that is 100% compliant with standards. The percentage of rooms without proper temperature norms was 21.42%. The rate of rooms with inadequate noise requirements was 17.86%. Spaces without 50% relative humidity norms. SBS symptoms: 10.3% of respondents said they always had itchy skin, and 27.6% said they frequently experienced extreme stress and exhaustion symptoms. Conclusion: There was no effect of temperature, lighting, or noise in the room regarding the sick building syndrome symptoms of officers in the outpatient room, except humidity. However, most workers felt SBS symptoms. Officer productivity was not impacted by the physical quality of the air or by sick building syndrome symptoms.

Abstract Human impacts are dramatically changing ecological communities, motivating research on resilience. Tropical reefs are increasingly undergoing transitions to short algal turf, a successional community that mediates either recovery to coral by allowing recruitment or transitions to longer turf/macroalgae. Intense herbivory limits turf height; subsequently, overfishing erodes resilience of the desirable coral-dominated reef state. Increased sedimentation also erodes resilience through smothering and herbivory suppression. In spite of this critical role, most herbivory studies on tropical reefs focus on fishes, and the contribution of urchins remains under-studied. To test how different herbivory and sedimentation scenarios impact turf resilience, we experimentally simulated, in situ, four future overfishing scenarios derived from patterns of fish and urchin loss in other reef systems and two future sedimentation regimes. We found urchins were critical to short turf resilience, maintaining this state even with reduced fish herbivory and increased sediment. Further, urchins cleared sediment, facilitating fish herbivory. This study articulates the likelihood of increased reliance on urchins on impacted reefs in the Anthropocene.

This study examines the public discourse about vaccines on Twitter during the COVID-19 pandemic and compares it with the discourses about vaccines before the pandemic. Discourse, users’ profile, content, tone, vaccines, and sources of information were manually coded. We have identified a diversity of discourses related to vaccines. The discourse that has stood out the most during the pandemic is related to pandemic management measures. Nevertheless, both denialist and anti-denialist discourses are reduced compared to the previous period. Besides this, less polarization and more neutral discourse were identified during the pandemic. The two periods are expressly marked by tweets with content related to opinions and personal experiences regarding vaccines. Some of them are characterized, in general, by informality in how the users communicate their ideas. Interestingly, users from the medical-scientific sphere did not participate more in Twitter during the pandemic. There were fewer posts including scientific findings and more tweets about patient resources. On the other hand, the media and journalists were very active in this period by disseminating information and issuing vaccine opinions, reflecting their essential role in health crises. However, the presence of television channels, such as Fox News, can be an indication of conservative ideas on vaccines. Thus, the discourses have expressed different meanings in relation to the issue and disputed their legitimacy in this symbolic and virtual market.

The mental health impacts of HIV have evolved significantly over the last four decades, in parallel with changes in the virus's overall health consequences. This study charts transformation in narratives about mental health problems associated with HIV over the course of the epidemic, as outlined by people with HIV (40%), professional carers (45%) and activists (25%) in the UK. In particular, our study examines evolving mental health impacts and changing service provision during three key periods: The early days of the epidemic; after the introduction of effective antiretroviral therapy (ART) in 1996; and in more recent times as HIV came to be regarded as a chronic manageable condition. Fifty-three participants were recruited: Male (68%), female (32%), White (90%), African/Afro Caribbean (6%) and South Asian (4%). Results indicate that despite important changes in the severity and nature of the mental health impacts of HIV, there were persistent challenges, related to the long-term mental health consequences of HIV among earlier generations of people with HIV. There were additional challenges associated with: ageing with HIV; the development of sexual dysfunction; and the possibility of neurocognitive impairment. The organization of mental health care for people with HIV moved from specialist teams to general practice, presenting challenges of mainstreaming care. The commissioning and delivery of mental health services need to be sensitive to the ever-changing social contexts and the potential for ‘left behind’ people living with HIV, despite the overall ‘naturalisation’ of HIV.

Human H3N2 influenza viruses are subject to rapid antigenic evolution which translates into frequent updates of the composition of seasonal influenza vaccines. Despite these updates, the effectiveness of influenza vaccines against H3N2-associated disease is suboptimal. Seasonal influenza vaccines primarily induce hemagglutinin-specific antibody responses. However, antibodies directed against influenza neuraminidase (NA) also contribute to protection. Here, we analysed the antigenic diversity of a panel of N2 NAs derived from human H3N2 viruses that circulated between 2009 and 2017. The antigenic breadth of these NAs was determined based on the NA inhibition (NAI) of a broad panel of ferret and mouse immune sera that were raised by infection and recombinant N2 NA immunisation. This assessment allowed us to distinguish at least four antigenic groups in the N2 NAs derived from human H3N2 viruses that circulated between 2009 and 2017. Computational analysis further revealed that the amino acid residues in N2 NA that have a major impact on susceptibility to NAI by immune sera are in proximity of the catalytic site. Finally, a machine learning method was developed that allowed to accurately predict the impact of mutations that are present in our N2 NA panel on NAI. These findings have important implications for the renewed interest to develop improved influenza vaccines based on the inclusion of a protective NA antigen formulation.

Background Sexually transmitted infections (STIs), along with sexual health and behaviour, have received little attention in schizophrenia patients. Aims To systematically review and meta-analytically characterise the prevalence of STIs and sexual risk behaviours among schizophrenia patients. Method Web of Science, PubMed, BIOSIS, KCI-Korean Journal Database, MEDLINE, Russian Science Citation Index, SciELO and Cochrane Central Register were systematically searched from inception to 6 July 2023. Studies reporting on the prevalence or odds ratio of any STI or any outcome related to sexual risk behaviours among schizophrenia samples were included. PRISMA/MOOSE-compliant (CRD42023443602) random-effects meta-analyses were used for the selected outcomes. Q-statistics, I2 index, sensitivity analyses and meta-regressions were used. Study quality and publication bias were assessed. Results Forty-eight studies (N = 2 459 456) reporting on STI prevalence (including 15 allowing for calculation of an odds ratio) and 33 studies (N = 4255) reporting on sexual risk behaviours were included. Schizophrenia samples showed a high prevalence of STIs and higher risks of HIV (odds ratio = 2.11; 95% CI 1.23–3.63), hepatitis C virus (HCV, odds ratio = 4.54; 95% CI 2.15–961) and hepatitis B virus (HBV; odds ratio = 2.42; 95% CI 1.95–3.01) infections than healthy controls. HIV prevalence was higher in Africa compared with other continents and in in-patient (rather than out-patient) settings. Finally, 37.7% (95% CI 31.5–44.4%) of patients were sexually active; 35.0% (95% CI 6.6–59.3%) reported consistent condom use, and 55.3% (95% CI 25.0–82.4%) maintained unprotected sexual relationships. Conclusions Schizophrenia patients have high prevalence of STIs, with several-fold increased risks of HIV, HBV and HCV infection compared with the general population. Sexual health must be considered as an integral component of care.

The Internet of Things (IoT) facilitates intelligent building management by deploying IoT devices as crucial components of building subsystems. However, the ongoing evolution of intelligent buildings presents challenges in network management, scalability, and security. In this regard, smart buildings require innovative network architectures capable of adapting to meet future requirements. The Recursive InterNetwork Architecture (RINA) emerges as a clean slate network architecture aiming to overcome various current network limitations and simplify network complexity. While RINA has demonstrated several advantages in multi-homing, scalability, and security, these benefits must be analyzed in realistic conditions. This paper introduces a RINA-based environment monitoring subsystem that implements and deploys RINA components within specific IoT hardware and software in a relevant environment. The subsystem comprises several RINA sensors, RINA-based IoT gateways, and an edge node. The subsystem’s design and implementation details are provided for efficient and secure communication between RINA sensors and the edge node. The RINAsense architecture was used to implement the sensors, with additional enhancements for resource management and energy efficiency. Also, the IRATI open-source software facilitates the implementation of the IoT gateway and edge node to ensure smooth RINA communications within the subsystem. The subsystem was evaluated in terms of latency, goodput, and energy consumption, and it achieved a 2.05-millisecond delay, 0.86 Mbps as goodput, and reduced 82% energy consumption. Finally, the feasibility of using RINA in smart buildings was confirmed by integrating the proposed subsystem into an operative intelligent building system.

Bioelectric signal classification is a flourishing area of biomedical research, however conducting this research in a clinical setting can be difficult to achieve. The lack of inexpensive acquisition hardware can limit researchers from collecting and working with real-time data. Furthermore, hardware requiring direct connection to a computer can impose restrictions on typically mobile clinical settings for data collection. Here, we present an open-source ADS1299-based bioelectric signal acquisition system with wireless capability suitable for mobile data collection in clinical settings. This system is based on the ADS_BP and BioPatRec, both open-source bioelectric signal acquisition hardware and MATLAB-based pattern recognition software, respectively. We provide 3D-printable housing enabling the hardware to be worn by users during experiments and demonstrate the suitability of this platform for real-time signal acquisition and classification. In conjunction, these developments provide a unified hardware-software platform for a cost of around ${\$}$ 150 USD. This device can enable researchers and clinicians to record bioelectric signals from non-disabled or motor-impaired individuals in laboratory or clinical settings, and to perform offline or real-time intent classification for the control of robotic and virtual devices.

Sensorimotor impairment is a prevalent condition requiring effective rehabilitation strategies. This study introduces a novel wearable device for Mindful Sensorimotor Training (MiSMT) designed for sensory and motor rehabilitation. Our MiSMT device combines motor training using myoelectric pattern recognition along sensory training using two tactile displays. This device offers a comprehensive solution, integrating electromyography and haptic feedback, lacking in existing devices. The device features eight electromyography channels, a rechargeable battery, and wireless Bluetooth or Wi-Fi connectivity for seamless communication with a computer or mobile device. Its flexible material allows for adaptability to various body parts, ensuring ease of use in diverse patients. The two tactile displays, with 16 electromagnetic actuators each, provide touch and vibration sensations up to 250 Hz. In this proof-of-concept study, we show improved two-point discrimination after 5 training sessions in participants with intact limbs (p=0.047). We also demonstrated successful acquisition, processing, and decoding of myoelectric signals in offline and online evaluations. In conclusion, the MiSMT device presents a promising tool for sensorimotor rehabilitation by combining motor execution and sensory training benefits. Further studies are required to assess its effectiveness in individuals with sensorimotor impairments. Integrating mindful sensory and motor training with innovative technology can enhance rehabilitation outcomes and improve the quality of life for those with sensorimotor impairments.

The development of advanced prosthetic devices that can be seamlessly used during an individual’s daily life remains a significant challenge in the field of rehabilitation engineering. This study compares the performance of deep learning architectures to shallow networks in decoding motor intent for prosthetic control using electromyography (EMG) signals. Four neural network architectures, including a feedforward neural network with one hidden layer, a feedforward neural network with multiple hidden layers, a temporal convolutional network, and a convolutional neural network with squeeze-and-excitation operations were evaluated in real-time, human-in-the-loop experiments with able-bodied participants and an individual with an amputation. Our results demonstrate that deep learning architectures outperform shallow networks in decoding motor intent, with representation learning effectively extracting underlying motor control information from EMG signals. Furthermore, the observed performance improvements by using deep neural networks were consistent across both able-bodied and amputee participants. By employing deep neural networks instead of a shallow network, more reliable and precise control of a prosthesis can be achieved, which has the potential to significantly enhance prosthetic functionality and improve the quality of life for individuals with amputations.

Motion intent recognition for controlling prosthetic systems has long relied on machine learning algorithms. Artificial neural networks have shown great promise for solving such nonlinear classification tasks, making them a viable method for this purpose. To bring these advanced methods and algorithms beyond the confines of the laboratory and into the daily lives of prosthetic users, self-contained embedded systems are essential. However, embedded systems face constraints in size, computational power, memory footprint, and power consumption, as they must be non-intrusive and discreetly integrated into commercial prosthetic components. One promising approach to tackle these challenges is to use network quantization, which allows complying with limitations without significant loss in accuracy. Here, we compare network quantization performance for self-contained systems using TensorFlow Lite and the recently developed QKeras platform. Due to internal libraries, the use of TensorFlow Lite led to a 8 times higher flash memory usage than that of the unquantized reference network, disadvantageous for self-contained prosthetic systems. In response, we offer open-source code solutions that leverage the QKeras platform, effectively reducing flash memory requirements by 24 times compared to Tensorflow Lite. Additionally, we conducted a comprehensive comparison of state-of-the-art microcontrollers. Our results reveal that the adoption of new architectures offers substantial reductions in inference time and power consumption. These improvements pave the way for real-time decoding of motor intent using more advanced machine learning algorithms for daily life usage, possibly enabling more reliable and precise control for prosthetic users.

Highly impaired individuals stand to benefit greatly from cutting-edge bionic technology, however concurrent functional deficits may complicate the adaptation of such technology. Here, we present a case in which a visually impaired individual with bilateral burn injury amputation was provided with a novel transradial neuromusculoskeletal prosthesis comprising skeletal attachment via osseointegration and implanted electrodes in nerves and muscles for control and sensory feedback. Difficulties maintaining implant hygiene and donning and doffing the prosthesis arose due to his contralateral amputation, ipsilateral eye loss, and contralateral impaired vision necessitating continuous adaptations to the electromechanical interface. Despite these setbacks, the participant still demonstrated improvements in functional outcomes and the ability to control the prosthesis in various limb positions using the implanted electrodes. Our results demonstrate the importance of a multidisciplinary, iterative, and patient-centered approach to making cutting-edge technology accessible to patients with high levels of impairment.

Abstract Switchable tribological properties of ferroelectrics offer an alternative route to visualize and control ferroelectric domains. Here, we observe the switchable friction and wear behavior of ferroelectrics using a nanoscale scanning probe—down domains have lower friction coefficients and show slower wear rates than up domains and can be used as smart masks. This asymmetry is enabled by flexoelectrically coupled polarization in the up and down domains under a sufficiently high contact force. Moreover, we determine that this polarization-sensitive tribological asymmetry is widely applicable across various ferroelectrics with different chemical compositions and crystalline symmetry. Finally, using this switchable tribology and multi-pass patterning with a domain-based dynamic smart mask, we demonstrate three-dimensional nanostructuring exploiting the asymmetric wear rates of up and down domains, which can, furthermore, be scaled up to technologically relevant (mm–cm) size. These findings demonstrate that ferroelectrics are electrically tunable tribological materials at the nanoscale for versatile applications.

Abstract Neurocognitive deficits are a core feature of psychotic disorders, but it is unclear whether they affect all individuals uniformly. The aim of this systematic review and meta-analysis was to synthesize the evidence on the magnitude, progression, and variability of neurocognitive functioning in individuals with first-episode psychosis (FEP). A multistep literature search was conducted in several databases up to November 1, 2022. Original studies reporting on neurocognitive functioning in FEP were included. The researchers extracted the data and clustered the neurocognitive tasks according to the seven Measurement and Treatment Research to Improve Cognition in Schizophrenia (MATRICS) domains and six additional domains. Random-effect model meta-analyses, assessment of publication biases and study quality, and meta-regressions were conducted. The primary effect size reported was Hedges g of (1) neurocognitive functioning in individuals at FEP measuring differences with healthy control (HC) individuals or (2) evolution of neurocognitive impairment across study follow-up intervals. Of 30,384 studies screened, 54 were included, comprising 3,925 FEP individuals and 1,285 HC individuals. Variability analyses indicated greater variability in FEP compared to HC at baseline and follow-up. We found better neurocognitive performance in the HC group at baseline and follow-up but no differences in longitudinal neurocognitive changes between groups. Across the 13 domains, individuals with FEP showed improvement from baseline in all studied domains, except for visual memory. Metaregressions showed some differences in several of the studied domains. The findings suggest that individuals with FEP have marked cognitive impairment, but there is greater variability in cognitive functioning in patients than in HC. This suggests that subgroups of individuals suffer severe disease-related cognitive impairments, whereas others may be much less affected. While these impairments seem stable in the medium term, certain indicators may suggest potential further decline in the long term for a specific subgroup of individuals, although more research is needed to clarify this. Overall, this study highlights the need for tailored neurocognitive interventions for individuals with FEP based on their specific deficits and progression.

Neonatal hypoxia–ischemia is a major cause of infant death and disability. The only clinically accepted treatment is therapeutic hypothermia; however, cooling is less effective in the most severely encephalopathic infants. Here, we wanted to test the neuroprotective effect of the antioxidant dimethyl fumarate after severe hypoxia–ischemia in neonatal rats. We used a modified Rice–Vannucci model to generate severe hypoxic–ischemic brain damage in day 7 postnatal rats, which were randomized into four experimental groups: Sham, Sham + DMF, non-treated HI, and HI + DMF. We analyzed brain tissue loss, global and regional (cortex and hippocampus) neuropathological scores, white matter injury, and microglial and astroglial reactivity. Compared to non-treated HI animals, HI + DMF pups showed a reduced brain area loss (p = 0.0031), an improved neuropathological score (p = 0.0016), reduced white matter injuries by preserving myelin tracts (p < 0.001), and diminished astroglial (p < 0.001) and microglial (p < 0.01) activation. After severe hypoxia–ischemia in neonatal rats, DMF induced a strong neuroprotective response, reducing cerebral infarction, gray and white matter damage, and astroglial and microglial activation. Although further molecular studies are needed and its translation to human babies would need to evaluate the molecule in piglets or lambs, DMF may be a potential treatment against neonatal encephalopathy.

The mechanisms underlying the sustained activation of the PI3K/AKT and Wnt/β-catenin pathways mediated by HOTAIR in cervical cancer (CC) have not been extensively described. To address this knowledge gap in the literature, we explored the interactions between these pathways by driving HOTAIR expression levels in HeLa cells. Our findings reveal that HOTAIR is a key regulator in sustaining the activation of both signaling pathways. Specifically, altering HOTAIR expression—either by knockdown or overexpression—significantly influenced the transcriptional activity of the PI3K/AKT and Wnt/β-catenin pathways. Additionally, we discovered that HIF1α directly induces HOTAIR transcription, which in turn leads to the epigenetic silencing of the PTEN promoter via DNMT1. This process leads to the sustained activation of both pathways, highlighting a novel regulatory axis involving HOTAIR and HIF1α in cervical cancer. Our results suggest a new model in which HOTAIR sustains reciprocal activation of the PI3K/AKT and Wnt/β-catenin pathways through the HOTAIR/HIF1α axis, thereby contributing to the oncogenic phenotype of cervical cancer.

Abstract Introduction Childhood trauma is a severe form of stress that has been strongly related to both the appearance of a psychotic disorder and the existance of social cognition disturbances. We hereby hypothesize childhood trauma might be a transdiagnostic marker of social cognition disturbances across the psychosis spectrum, regardless of the main diagnosis. Objectives To investigate the effect of different forms of childhood trauma in social cognition impairments in first-episode psychosis, at-risk mental states for psychosis and healthy controls. Methods Using cross-sectional data, we will examine the relationship between different kinds of chidlhood trauma (measured with the Childhood Trauma Questionnaire, CTQ) and several social cognition domains, including facial emotion recognition, theory of mind (assessed using the Movie Assessment for Social Cognition, MASC, The Hinting Task, and the Faux-Pas Questionnaire). Intra and inter-group differences be studied for three study groups, including patients with first-episode psychosis (n=60), subjects with at-risk mental states for psychosis (n=60), and healthy controls (n=60). Disclosure of Interest None Declared

Background: The effectiveness of long-acting injectable (LAI) antipsychotics in preventing relapses of first-episode psychosis is currently debated. Objectives: The study aimed to investigate the number of psychiatric hospitalizations comparing the LAI cohort versus the oral cohort during different phases of the illness, pre-LAI treatment, during LAI treatment, and after LAI treatment. Design: A naturalistic study was conducted on two independent cohorts of early psychosis patients receiving treatment from a specific early intervention service. The first cohort comprised 228 patients who received LAIs, while the second cohort comprised 667 patients who had never received LAIs. Methods: This study was designed as a longitudinal observational study conducted within a naturalistic clinical setting in two cohorts of early psychosis patients. Repeated series ANCOVA (ANCOVA-r) was used to study the number of hospitalizations in the different study periods (T1 = from the date of the first psychiatric record to the beginning of the mirror period; T2 = the mirror period; T3 = from the LAI implementation to the LAI discontinuation; and T4 = from the LAI discontinuation to the end). In all cases, discontinuation of LAI involved the return to oral treatment. In all, 35 patients had not T4 as they were still on LAI treatment at the time of database closing (September 2020), and their data were not included in the analysis of the effect of the LAI discontinuation. Results: The patients in the LAI cohort were younger, more frequently males, presented more schizophrenia diagnoses, and had a higher number of hospitalizations (2.50 ± 2.61 versus 1.19 ± 1.69; p

IntroductionThe COVID-19 pandemic has significantly impacted mental health globally, leading to a deterioration in the overall mental health of the population and changes across all healthcare levels, including emergency departments (ED). However, the evolution of the quantity and nature of psychiatric ED visits in the post-pandemic period remains uncertain.AimsTo examine changes in the number and nature of psychiatric emergencies at a general hospital before, during, and after the COVID-19 pandemic.Materials and methodsPsychiatric ED visits from a tertiary hospital in the Basque Country (Spain) between January 2019 and November 2023 were investigated. Electronical health registers detailing the number and nature of psychiatric care consultations were analyzed for the study timeframe. Three periods were then compared: pre-pandemic (from January 2019 to February 2020), pandemic (from March 2020 to January 2022), and post-pandemic (from February 2022 onwards).Results16,969 psychiatric ED visits were recorded for the study period. The number of psychiatric ED visits remained stable from pre-pandemic (269.93 visits/month) to pandemic (264.48 visits/month) periods but experienced a significant rise during the post-pandemic period (330.00 visits/month; t=-6.42; p