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Predictors of psychiatric emergency department visits within twelve months post-inpatient psychiatric discharge in Alberta, Canada

Background Psychiatric emergency department (ED) visits following discharge from inpatient psychiatric care remain a significant challenge for mental health systems and may reflect gaps in continuity of care and community support. While sociodemographic and clinical predictors of recurrent ED utilization have been widely studied, the role of inpatient satisfaction and transitional care interventions in predicting post-discharge psychiatric ED visits remains less clear. Objectives This study aimed to examine predictors of psychiatric ED visits within 12 months following discharge from acute psychiatric inpatient units, with particular focus on inpatient satisfaction, prior ED utilization, intervention exposure, sociodemographic characteristics, and clinical factors. Methods This observational cohort analysis used data from participants recruited through a pragmatic stepped-wedge transitional care study in Alberta, Canada. A multivariable logistic regression model was conducted to identify predictors of psychiatric ED visits within 12 months post-discharge. Predictor variables included intervention group [treatment as usual (TAU), supportive text messaging (SMS), and supportive text messaging combined with peer support (SMS + PS)], prior ED visits within 6 months before index admission, inpatient satisfaction, sociodemographic variables, and clinical characteristics. Results The study included 1,070 participants. Prior psychiatric ED visits within 6 months preceding the index admission emerged as the strongest predictor of post-discharge psychiatric ED utilization. Unemployment and housing instability were also significantly associated with increased likelihood of ED visits within 12 months following discharge. In contrast, inpatient satisfaction, intervention group, gender, ethnicity, relationship status, resilience, wellbeing, depression, and anxiety measures were not independently associated with post-discharge psychiatric ED visits. Conclusion Psychiatric ED visits following discharge were primarily associated with prior ED utilization and socioeconomic factors, particularly unemployment and housing instability. Although inpatient satisfaction represents an important component of patient-centered psychiatric care, it was not independently associated with subsequent psychiatric ED visits in this cohort. These findings highlight the importance of addressing structural and social determinants alongside transitional care planning to reduce recurrent psychiatric ED utilization.

Long-term ocular symptoms following COVID-19 linked to immune dysregulation, dysautonomia and peripheral neuropathy

Abstract COVID-19 does not require hospitalization in most cases, but post-acute sequelae can persist and are a public health concern. In a prospective cross-sectional study, we examine persistent ocular symptoms (POS) emerging in non-hospitalized individuals after COVID-19, with individuals without POS post-recovery as controls. Using symptom and quality of life data, clinical examinations and biofluid proteomics, we document ocular symptoms persisting from 3 months up to 3 years post-infection. POS lead to significant vision disability and are linked to clinical findings not detectable in routine exams but only with specialized tests. POS include near vision disturbances, strabismus, weakened autonomic pupillary reflexes, corneal neurodegeneration and chronic activation of ocular surface dendritic/T cells. We report a tear film proteomic profile consistent with severe COVID-19, chronic dysregulation of CD4 + T cell regulatory activity, upregulation of ITGB6, NFASC, CTGF, TPSAB1 and CKMT1A-CKMT1B, pupil dysfunction correlating with elevated JUN, and dendritic/T cell dysregulation correlating with elevated ANGPTL2, SKAP2 and DAPP1 levels. Diagnostic models based on clinical examinations with or without biomarkers predict POS with 77-91% accuracy and implicate chronic T cell-mediated neuroinflammation in the pathogenesis of POS, a debilitating syndrome arising after COVID-19 recovery and characterized by strabismus, ocular dysautonomia and peripheral ocular neuropathy.

Human-elephant conflict in communities bordering Kruger National Park: Revealing causes and unpicking social media narratives

Conflict between humans and wildlife in communities living adjacent to protected areas is one of the most intractable issues facing policymakers and conservation practitioners. The presence of wildlife can negatively impact on humans in a number of different ways, from fatalities to loss of livelihoods. Proximity to human communities can also negatively impact wildlife, for example through retaliatory killings and illegal harvesting. Meeting conservation objectives therefore often requires measures to reduce human-wildlife conflict, especially at the borders of national parks. We examine the drivers of human-elephant conflict occurring in villages bordering Kruger National Park (KNP), South Africa – which can result in the killing of elephants that enter these communities. We use data from surveys in these communities, as well as online descriptions of an incident in the village of Matsulu which resulted in the death of an elephant and which was filmed by several community members, generating a large number of social media stories. Social media stories and survey responses both highlighted the same underlying drivers of elephant killings: that members of the community appear to have tampered with the KNP fence and encouraged elephants to exit the park. Community members benefited through obtaining elephant meat. Data from the survey additionally indicated that a small number of community members profit financially from elephant escapes, but that the wider community experiences a range of negative impacts, which may be partially defrayed by benefits in the form of meat. The majority (71.2%) of survey respondents stated they would support non-lethal elephant management approaches. The current policy regarding elephant management in KNP is that elephants are protected within the park but if outside and considered a danger to humans are permitted to be killed. This policy has implications for elephant conservation in a context where members of local communities may feel incentivised to facilitate the escape of elephants, in order to benefit from legitimately killing them. We recommend an evaluation of this policy in the light of community attitudes towards elephants and their management.

Twist-tuned exchange and hysteresis in a bilayer van der Waals magnet

Abstract Moiré superlattices in twisted bilayers enable strong reconstruction of electronic band structures, giving rise to correlated phases with high tunability. Extending this concept to van der Waals magnets, we show that twisting induces spatially varying interlayer exchange interactions that can stabilize complex magnetic responses. Here, we demonstrate robust magnetic hysteresis in bilayer CrSBr upon a twist of  ~ 3°, observed as a hysteretic evolution of exciton energies that directly track the underlying magnetic configuration in field-dependent photoluminescence measurements. An analytic two-sublattice model captures this behaviour, attributing it to a twist-induced reduction of interlayer exchange that stabilizes both parallel and antiparallel spin states over a broad field range. Spatially resolved measurements reveal local variations in hysteresis loops, consistent with position-dependent modulation of magnetic parameters. In certain regions, coherent averaging over the moiré unit cell yields an effective monodomain-like response. Our results establish twist engineering as a route to programmable magnetism in two-dimensional antiferromagnets.

Assessing the content validity of the migrant health country profile tools in Tunisia: A mixed methods study protocol

Introduction Human migration is a historical constant, yet integrating migrant populations into health policy and systems remains a challenge. As highlighted by UN agencies and The Lancet Migration Commission, a key issue exacerbating inequities is the lack of data on disease indicators and healthcare access for migrants, with existing datasets often fragmented. Our transdisciplinary consortium co-developed the Migrant Health Country Profile tools (MHCP-t) – an innovative package of three survey tools that nationally map migrant health data sources ( MHCP-t: Data tool ), document migrant health policies and the integration of migrants in policies ( MHCP-t: Policy tool ), and the integration of migrants into healthcare provision ( MHCP-t: Provision tool ) for key diseases. This protocol describes a mixed-methods validation study investigating the content validity, feasibility, and acceptability of the MHCP-t in Tunisia. Methods We will recruit a purposive sample of 40–50 national experts in migration health to complete one of the three MHCP-t according to their expertise. Two subsequent surveys will evaluate: 1) item-level content validity (relevance, comprehensiveness, and comprehensibility for individual items) for the MHCP-t: Policy and MHCP-t: Provision , where items function as indicators of the extent to which migrants are integrated into health policies and service provision and therefore require direct assessment at the item level, and 2) tool-level validity, feasibility, and acceptability for all three tools, including the MHCP-t: Data tool, where the primary objective is to assess the comprehensiveness and relevance of the inventory as a whole rather than the validity of individual items as indicators. This will be followed by focus group discussions with a nested sub-sample of approximately 10–15 participants from the initial survey to provide qualitative depth of participants’ perspectives. Item-level content validity will be analysed using the Item/Scale Content Validity Indices and Krippendorff’s Alpha (α). To assess the level of agreement, the interquartile range will be calculated for each item based on Likert scale ratings (1–5). The second survey will be analysed using descriptive statistics while qualitative data will undergo thematic analysis. Discussion Findings will be disseminated via peer-reviewed publications, conferences, and other formats relevant to different stakeholders. By integrating these findings, the study will determine the tools’ appropriateness for mapping migrant health data sources, policies, and service provision, informing their potential for wider national rollout across the MENA region and other contexts.

Particle-associated diazotrophs drive nitrogen fixation in Arctic subsurface waters of the Barents Sea

Abstract Biological dinitrogen (N 2 ) fixation sustains productivity in oligotrophic oceans and is now also thought to contribute substantially to the nitrogen supply in the warming Arctic. Here we demonstrate significant N 2 fixation by particle-associated diazotrophs in subsurface waters of the Barents Sea. Comparing our findings with subtropical studies reveals particle-associated non-cyanobacterial diazotrophs as the primary N 2 fixers in subsurface Arctic waters of the Barents Sea, contrasting with diverse communities in warmer regions. As the Arctic shifts towards oligotrophication, understanding the magnitude and controls of particle-associated N 2 fixation will provide critical insights into future nitrogen supply required to sustain productivity in the rapidly changing Arctic Ocean. However, particle-associated N 2 fixation may be a distinctive feature of the Barents Sea, where in contrast to other Arctic shelves the seasonal and long-term trends in nitrogen dynamics are heterogeneously determined by changes in the external Atlantic Water supply, sea-ice extent, and terrestrial inputs. In this context, the role of particle-associated N 2 fixation across the wider Arctic Ocean will require further investigation.

An exact and interpretable test for detecting aging behavior in reliability and survival data

The identification of aging behavior in reliability and survival data is a central problem with important implications for risk assessment, system reliability, and decision-making in applied fields. The exponential model serves as the standard benchmark corresponding to the absence of aging, making the detection of departures from this model a key statistical task. This paper develops an exact nonparametric test for detecting increasing failure rate in average (IFRA) type aging in complete lifetime data. The test is constructed through a deviation functional derived from the defining properties of the IFRA class, providing a structurally meaningful and practically interpretable measure of departure from exponentiality. A main contribution is the derivation of an exact finite-sample representation of the test statistic under the exponential model using a normalized spacings framework, allowing accurate inference without reliance on asymptotic approximations. An asymptotic normal characterization is also established to support efficient large-sample implementation. To enhance practical applicability, a scale-invariant formulation is developed to remove dependence on unknown parameters. The performance of the proposed method is evaluated through extensive Monte Carlo simulations under a range of alternative models, including linear failure rate, Makeham, Gamma, and Weibull distributions. The results demonstrate consistently strong empirical power and competitive performance relative to existing procedures across different sample sizes. The practical utility of the method is further illustrated through applications to real-world datasets, where it provides coherent and interpretable assessments of aging behavior. Overall, the proposed approach offers a statistically rigorous and practically relevant tool for detecting aging patterns in reliability and survival data, combining exact finite-sample validity, asymptotic tractability, and strong empirical performance. In practical terms, the test helps determine whether a system or population shows signs of aging (increasing average risk over time) or behaves as if failures occur randomly at a constant rate.

Pulmonary mRNA-LNP vaccines for rapid and durable protection against bacterial infection

Retraction: Convolutional neural network model by deep learning and teaching robot in keyboard musical instrument teaching

Unveiling the landscape of Mottness and its proximity to superconductivity in 4Hb-TaS2

The burden and epidemiology of orofacial clefts in Iran from 1990 to 2023: a Global Burden of Disease study with subnational socio-demographic index analysis

Background Orofacial clefts (OFCs) are among the most frequent congenital craniofacial malformations worldwide. These conditions impose lifelong functional, psychological, and socioeconomic burdens. In Iran, despite several hospital-based and regional studies, an updated national and subnational assessment of OFC burden has been lacking. This study aimed to estimate the incidence, prevalence, disability-adjusted life years (DALYs), and mortality attributable to OFCs in Iran and its 31 provinces from 1990 to 2023, and to explore their associations with the sociodemographic index (SDI). Methods Data were obtained from the Global Burden of Disease (GBD) Study 2023. OFCs were defined according to ICD-10 codes Q35–Q37. GBD modeled estimates were generated using the DisMod-MR 2.1 meta-regression framework. The DisMod-MR 2.1 meta-regression model was applied to derive estimates of metrics. Rates were age-standardized per 100,000 population, and 95% uncertainty intervals (UIs) were calculated. The relationship between OFC burden and SDI was assessed descriptively using smoothing splines models. Results In 2023, Iran recorded 1,208.9 (917.1–1,581.4) new OFC cases, corresponding to an age-standardized incidence rate of 2.5 per 100,000. Prevalence reached 77.3 (62.3–94.7) per 100,000, and DALYs were 6.9 (4.1–10.5) per 100,000. Since 1990, DALY and mortality rates decreased by 88.8% and 96.1%, respectively, while prevalence remained largely stable. The highest prevalence was seen in Tehran (108.3 per 100,000) and the lowest in Isfahan (49.1 per 100,000). The greatest DALY burden occurred among children under five years. There was a negative relationship between SDI and DALY rates. Conclusions The national burden of OFCs in Iran has substantially declined over the past three decades. These findings highlight the need for sustained efforts to improve cleft prevention, early detection, and access to specialized care to further reduce the burden and promote health equity across Iran.

Gut microbiota associates with frailty in older women

Abstract Frailty is a multifactorial geriatric condition linked to increased mortality and adverse health outcomes and is associated with gut microbiome features that differ from those observed in healthy ageing. We analyze gut metagenomic profiles in relation to estimated frailty severity and frailty-related clinical outcomes assessed with an internally developed and validated Frailty Mortality Index (FMI) in the SUPERB cohort, comprising 2,081 Swedish women aged 75–80 years. The FMI is a composite measure that integrates functional, physiological and psychological dimensions associated with frailty and mortality risk, and shows stronger associations with mortality compared to the Charlson Comorbidity Index in the SUPERB cohort. The FMI is inversely associated with microbial diversity, gene richness, and predicted functional capacity, which are linked to physical function, mortality and fall-related injuries. A total of 404 bacterial species are significantly associated with FMI, and most show concordant associations in a Chinese cohort of 1,448 older adults. Here we show microbial signatures linked to frailty and mortality across different continents.

Pascal selective laser trabeculoplasty (PSLT) in the treatment of ocular hypertension and open-angle glaucoma compared to travoprost eye drops: A non-inferiority clinical trial

Aims To compare the effectiveness of PSLT and the use of topical prostaglandin eye drops in the treatment of ocular hypertensive (OHT) or open-angle glaucoma patients (POAG) in reducing intraocular pressure (IOP) and peak IOP. Methods This is a non-inferiority randomized clinical trial, after washout, both patients eyes were randomized, one eye treated with PSLT (intervention group) and the contralateral eye treated with travoprost eye drops (controls). IOP, peak IOP by water drinking test (WDT), visual field (VF) and OCT were performed at baseline and at 7 days, 2, 6, 9 and 12 months after treatment. The primary outcome measure was to assess if the impact of PSLT on IOP and peak IOP is not inferior to that of the standard treatment (travoprost eye drops) by a margin not greater than the predefined threshold of 1.5 mmHg. Results A total of 30 patients participated in this trial. The mean baseline IOP was similar in both groups, 18.8 ± 4.0 mmHg and 18.8 ± 4.2 mmHg, intervention and control respectively. At 2, 6 and 9 months of treatment no significant difference in IOP was found between the two groups. At 12 months of follow-up the PSLT group showed lower average IOP (13.5 ± 2.3 mmHg versus 14.9 ± 2.7 and p < 0.001). Similar results were found for peak IOP in the WDT. On average there was no progression over time and no significant difference between groups regarding VF and OCT parameters. Conclusion PSLT was as effective as prostaglandin eye drops in reducing IOP and IOP peak in POAG and OHT patients. These findings are especially important as interest grows in minimally invasive glaucoma treatments and reducing reliance on topical medications. Trial registration Clinicaltrials.gov NCT05241938

Urbanization processes widen global divergence in extreme temperature variability

Abstract Extreme temperature variability (ETV) is a key dimension of climate risk for billions of residents. However, how urbanization shapes global ETV divergence remains unclear. Here, we assemble a 1950–2020 panel of 10,522 cities and demonstrate that ETV trajectories diverge by development status as measured by the human development index (HDI). ETV intensifies in high-development cities, whereas it slowly weakens in low-development cities, resulting in a current gap of roughly 1.66 °C. Decomposing ETV into event frequency and intensity reveals that cumulative ETV is driven mainly by intensity. Using an interpretable machine-learning framework, we find that aerosols are the urban factor most strongly associated with ETV after controlling for climate and geography. Blue-green space is consistently associated with lower ETV, whereas urban morphology has a smaller and context-dependent effect. These findings link global ETV inequality to urban governance and support targeted management that focusses on limiting volatility under climate risk.

MDA-MB-231 cell morphology influences chemotactic sensing of CXCL12 gradients in type 1 bovine collagen matrix

Chemotaxis plays a critical role in the metastatic progression of breast cancer. The chemokine CXCL12 is well recognized as an essential component of chemotactic migration in triple-negative breast cancer (TNBC) cells in vivo . The purpose of this study is to determine how the highly metastatic TNBC cell line, MDA-MB-231, migrates in response to well-defined CXCL12 gradients in vitro . Traditional 2D transwell migration assays were optimized to gauge the MDA-MB-231 cells’ responsiveness to various CXCL12 concentrations. The optimum chemoattractant concentrations were applied to a commercially available 3D chemotaxis assay as stable linearly diffused gradients. Cells were embedded in type 1 bovine collagen at two different collagen concentrations, and individual unlabeled cells were monitored for 24 hours using brightfield microscopy. Time-lapse videos were used to track cell movement and shape. Quantitative data analysis was performed using an automated tracking software to measure chemotactic parameters based on cell morphology. MDA-MB-231 cells were responsive to CXCL12 concentrations greater than 200 ng/mL in 2D and 3D systems. In 3D systems, significant directed migration was observed in denser collagen matrices. It was observed that in 3D matrices a range of cell morphologies was present. Therefore, chemotaxis was evaluated as a function of cell shape revealing some differences between sub cellular populations. Our findings show the cell’s shape influences the chemotactic sensing towards CXCL12 gradients.

Neuronal dynamics, timing, and flow of sensory and choice-related information in auditory-prefrontal circuitry

A novel COE-D8-fosfomycin conjugate effectively combats first-line antibiotic-resistant uropathogenic Escherichia coli

Recurrent urinary tract infections (UTIs) caused by multidrug-resistant uropathogenic Escherichia coli (UPEC) demand novel antimicrobial approaches. This study evaluated the membrane-intercalating conjugated oligoelectrolyte COE-D8 against 93 clinical UPEC isolates. While >75% of isolates exhibited high-level resistance to first-line antibiotics (MIC > 512 μg/mL), 94.6% remained susceptible to COE-D8 at ≤32 μg/mL. COE-D8 eliminated bacteria fourfold faster than standard antibiotics through membrane disruption driven by a dimensional mismatch with the lipid bilayer. To mitigate the inherent cytotoxicity of COE-D8 alone, we developed a synergistic co-administration strategy with fosfomycin. This approach achieved a significant dose-sparing effect, rescuing 7-day murine survival from 40% to 80% in safety models without compromising efficacy. Furthermore, resistance induction studies identified a high barrier to adaptation, with survival primarily mediated by mzrA mutations. These findings establish the COE-D8/fosfomycin combination as a host-friendly, mechanism-driven strategy against refractory UPEC.

Selenium atom transfer enables selective bridged alkene-arylamine cycloaddition

Optimizing treatment for depressed parents of children with emotional and behavioral disorders: A multi-site feasibility trial

Background Behavioral parent training (BPT) programs are effective for reducing disruptive behavior of many children with emotional and behavioral disorders (EBD) and improving skills and competencies of their parents. However, these interventions are not sufficiently effective for parents who themselves have depression. This study assessed the feasibility of the Addressing Depression and Positive Parenting Techniques (ADAPT) Program—a novel BPT that includes aspects of cognitive behavioral therapy and dialectical behavior therapy. We identified whether recruitment was possible, attendance was acceptable, participants were satisfied, and facilitators adhered to the protocol. Additionally, we measured trends in changes in parent and child outcomes with intervention. Methods Participants were 28 parents and their children with EBD, referred to two hospital-based clinics. Parents were eligible if they (1) had a child aged 6–10 experiencing emotional and behavioral difficulties and (2) were experiencing elevated depressive symptoms. ADAPT took place virtually over 10 weeks. Participants completed measures before, weekly and after treatment. Clinicians recorded attendance and completed weekly treatment fidelity checklists. Results We found that recruitment was possible, the intervention showed high parental satisfaction, and facilitators reported high program fidelity. Further, secondary outcome measures showed evidence of sensitivity to change in the intended direction. Conclusion Given that a priori progression criteria were met and we found preliminary indication of efficacy, we conclude that an RCT of ADAPT to determine efficacy is warranted.

Cellular heterogeneity of hepatic granuloma formation and evolution in murine schistosomiasis japonica

Abstract Schistosomiasis morbidity and mortality are primarily driven by egg-triggered granulomas with subsequent fibrosis. However, the dynamics of cellular composition within these granulomas, particularly the identity and function of key immune cells that orchestrate their formation and evolution, remain poorly understood. Here, we combine single-cell RNA sequencing with multiplex immunofluorescence to characterize the hepatic immune landscape in Schistosoma japonicum -infected mice and further validate the functional roles of two neutrophil subsets. We find that eggs alter hepatic immune cell composition, which is characterized by extensive neutrophil recruitment and differentiation. Neutrophil recruitment correlates with CXCL2 derived from both an autocrine loop and paracrine signaling from monocytes. Cellular localization analysis reveals that granulomas progress through three distinct developmental stages: early Ly6G hi F4/80 lo Desmin lo , developing Ly6G mid F4/80 hi Desmin mid , and advanced Ly6G lo F4/80 mid Desmin hi . Neutrophil subsets display a zonal distribution within granulomas, with CD177 + neutrophils surrounding the eggs and Ltf + neutrophils localizing to the mid-outer layer. Cd177 knockdown reduces granuloma size and fibrosis, whereas Ltf suppression increases these pathological features, indicating that CD177 and LTF exert opposite effects on granuloma formation. Our findings provide new insights into the cellular complexity of S. japonicum egg-induced granulomas and may help guide the development of novel therapies for liver fibrosis.