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Real-time assessment of triage nurse situational awareness (SA) using the situation awareness global assessment technique (SAGAT)

Background The emergency department (ED) is a complex, unpredictable, and distraction-filled environment. Within these challenging conditions, triage nurses are tasked with quickly assessing, identifying, and prioritizing patients who require urgent interventions. Studies from other safety-critical fields, such as aviation and the military, have highlighted that situational awareness (SA) is a critical skill for optimizing human performance during time-sensitive situations. In these fields, limitations in SA have been identified as significant risks to safety. However, despite its importance, SA in the context of EDs has been largely overlooked. Endsley’s SA theory and the Situation Awareness Global Assessment Technique (SAGAT) provide a framework to evaluate SA in dynamic and complex workspaces. This study aims to assess SA during real-time triage processes of patients in EDs, utilizing Endsley’s SA model. Method An observational cross-sectional study was conducted to assess SA. Forty real-time triaging processes were observed and evaluated in two ED sites, using the SAGAT to measure SA levels. Results A total of 40 triage nurses participated in the study across two ED sites. The findings revealed that the perception of patient cues was significantly reduced by workload (p = 0.048) and stress (p = 0.025), while playing video games was associated with enhanced perception of patient cues (p = 0.014). Additionally, a significant negative correlation was observed between the perception of patient cues and comprehension, indicating a cognitive trade-off between these two SA levels. Only 10% (n = 4) of participants achieved a good SA score, emphasizing the need for improvement. Conclusion The results underscore the importance of understanding and improving situational awareness in triage nurses using Endsley’s SA model. These findings offer valuable insights for enhancing future practice, education, and research focused on optimizing situational awareness in emergency nursing.

Effects of exogenous melatonin on the growth and photosynthetic characteristics of tomato seedlings under saline-alkali stress

Characterization of the atypical antipsychotic drug aripiprazole cytotoxicity in the neutrophil model cell line HL-60

Atypical antipsychotics are widely used for the treatment of mental and behavioral disorders such as bipolar disorder, obsessive-compulsive disorder, and schizophrenia. However, these drugs can occasionally induce neutropenia or agranulocytosis, characterized by a significant reduction in circulating neutrophils, the primary white blood cells responsible for immune responses. This drug-induced neutropenia poses a considerable risk of life-threatening infections. However, the precise mechanism by which atypical antipsychotics induce neutropenia remains unclear. This study investigates the effects of four atypical antipsychotics, namely – aripiprazole, clozapine, olanzapine, and quetiapine – on the human neutrophil model cell line HL-60. These drugs, which modulate dopamine receptor signaling alongside other mechanisms, were analyzed for their effects. Among these, aripiprazole – but not the others – uniquely induced apoptosis in a dose-dependent manner, accompanied by an increased expression of pro-apoptotic genes – BAK, BCL10, and caspase-3. Moreover, our study elucidates that while differentiated HL-60 cells express D1-like and D2-like dopamine receptors, aripiprazole’s cytotoxic effects appear to operate through dopamine-independent pathways and significantly reduce phosphorylated Src family kinase levels. Our results align with previous studies suggesting that aripiprazole exhibits cytotoxic properties in neutrophils. Nevertheless, further investigations are warranted to investigate the mechanisms underlying aripiprazole-induced apoptosis in neutrophils.

Correction: Mesoscale effects of trader learning behaviors in financial markets: A multi-agent reinforcement learning study

Comparison of respiratory symptoms and pulmonary functions of adult male cigarette smokers and non-smokers in Sri Lanka; A comparative analytical study

Background Cigarette smoking has long been associated with decreased lung function and increased respiratory symptoms globally. While this relationship is well-established, a critical gap exists in our understanding of the specific impact of smoking intensity on individual lung volumes, particularly among the general population. Despite numerous studies conducted on this topic worldwide, there is a noticeable absence of research focusing on the Sri Lankan population, and South Asian studies in this context remain sparse. This study evaluated the prevalence of respiratory symptoms and pulmonary function changes among chronic cigarette smokers and compared them with non-smokers. Furthermore, the proposed study intends to close this gap by undertaking a systematic assessment of the influence of cigarette smoking on lung function and respiratory symptoms in the general population of Sri Lanka. Additionally, the present research represents the first-ever Lung function study conducted in Sri Lanka specifically targeting cigarette smokers. Methods Adult male daily smokers (n = 360) and matched non-smokers (n = 180) from the Colombo district, Sri Lanka, were chosen. Smokers were compared in age, height, and weight with a matched nonsmoking control group. An interviewer provided a questionnaire to collect data on socio-demographic information, smoking behaviors, and clinical respiratory symptoms. Lung function tests were performed with a calibrated PC-based Medikro® Pro (Finland) spirometer and forced vital capacity (FVC), forced expiratory volume in 1 s (FEV1), and FEV1/ FVC ratio, peak expiratory flow (PEF), forced expiratory flow between 25% and 75% of FVC (FEF 25–75%) were measured. Results Smokers had a significantly higher prevalence of respiratory symptoms and significantly lower FVC, FEV1, FEV1/ FVC, and PEF, FEF 25–75% values than non-smokers. There was a significantly negative correlation of FVC, FEV1, FEV1/ FVC, and PEF, FEF 25–75% with the duration of smoking, and the Brinkman Index. According to the Multiple regression analysis, smoking significantly contributed to deteriorated pulmonary function variables. Conclusion This study revealed that continuous smoking accelerates the deterioration of lung function and increases respiratory symptoms. Early strategies to reduce tobacco use are recommended.

A novel framework for modeling quarantinable disease transmission

The COVID-19 pandemic has significantly challenged traditional epidemiological models due to factors such as delayed diagnosis, asymptomatic transmission, isolation-induced contact changes, and underreported mortality. In response to these complexities, this paper introduces a novel CURNDS model prioritizing compartments and transmissions based on contact levels, rather than merely on symptomatic severity or hospitalization status. The framework surpasses conventional uniform mixing and static rate assumptions by incorporating adaptive power laws, dynamic transmission rates, and spline-based smoothing techniques. The CURNDS model provides accurate estimates of undetected infections and undocumented deaths from COVID-19 data, uncovering the pandemic’s true impact. Our analysis challenges the assumption of homogeneous mixing between infected and non-infected individuals in traditional epidemiological models. By capturing the nuanced transmission dynamics of infection and confirmation, our model offers new insights into the spread of different COVID-19 strains. Overall, CURNDS provides a robust framework for understanding the complex transmission patterns of highly contagious, quarantinable diseases.

Sacrificial animals as evidence for the disintegration of the ritual and music system: A case study of the Zhuolu site (790-410 BC)

Ritual and music are important approaches to convey the ethical and moral concepts in the Zhou Dynasty (1046–256 BC) in China. The ritual and music (liyue) system, therefore, was established by the Duke of Zhou to maintain social order, create and strengthen the power of the Shang royalty. The essence of the system was the division of classes. The primary objective of this study was to analyze the sacrificial animals from the Zhuolu site (40°13´N, 115°24´E) in Hebei Province, China. We summarized the characteristics of sacrificial behavior during that period by examining the types of sacrificial animals and the specific parts of their bones. Ultimately, we discussed whether these characteristics align with the established rules of the ritual and music system. In this study, excavated animal bones were subjected to species identification, surface mark recording, and carbon and nitrogen stable isotope analyses. Skeletal surface marks and stable isotope analyses indicated that there are various methods by which people access and utilize animal resources. There are various animals, including pigs, deer, hares, ring-necked pheasants, and fish, were utilized in the burials. Included in these bones are not only the left and front parts of the body, but also the right part and the hind limbs. Not only is this inconsistent with the specified combination of animal species designated for sacrifice within the ritual and music system, but it also deviates from the requirement to utilize the left and front halves of the limbs. People may have changed and reduced the use of certain sacrificial animals according to their personal preferences and needs. This may be attributed to the disintegration of the ritual system during that period. By comparing different sites, it is possible to infer that the stringent execution of rules regarding the use of animals in burial rituals was directly related to the level of ritual system development during the period to which the site is associated.

The relation of nasopharyngeal colonization by Streptococcus pneumoniae in comorbid adults with unfavorable outcomes in a low-middle income country

Purpose Streptococcus pneumoniae (Spn) is the primary bacterial cause of lower respiratory tract infections (LRTI) globally, particularly impacting older adults and children. While Spn colonization in children is linked to LRTI, its prevalence, and consequences in adults with comorbidities remain uncertain. This study aims to provide novel data in that regard. Methods This prospective study of outpatient adults with chronic diseases was conducted in Colombia. Data on demographics, vaccination, and clinical history was collected in a RedCap database. Nasopharyngeal aspirate samples were examined for Spn colonization using traditional cultures and quantitative—real time polymerase chain reaction (q-rtPCR). Patients were followed for 18 months, with colonization prevalence calculated and factors influencing colonization and its impact on clinical outcomes analyzed through logistic regressions. Results 810 patients were enrolled, with 10.1% (82/810) identified as colonized. The mean (SD) age was 62 years (±15), and 48.6% (394/810) were female. Major comorbidities included hypertension (52.2% [423/810]), cardiac conditions (31.1% [252/810]), and chronic kidney disease (17.4% [141/810]). Among all, 31.6% (256/810) received the influenza vaccine in the previous year, and 10.7% (87/810) received anti-Spn vaccines. Chronic kidney disease (OR 95% CI; 2.48 [1.01–6.15], p = 0.04) and chronic cardiac diseases (OR 95% CI; 1.62 [0.99–2.66], p = 0.05) were independently associated with Spn colonization. However, colonization was not associated with the development of LRTI (OR 95%CI; 0.64 [0.14–2.79], p = 0.55) or unfavorable outcomes (OR 95% CI;1.17 [0.14–2.79], p = 0.54) during follow-up. Conclusions Chronic kidney and cardiac diseases are independently associated with Spn colonization. However, Spn colonization was not associated with LRTI/unfavorable outcomes in adult patients with chronic comorbidities in our cohort.

The portrayal of panic-buying and stockpiling in English newspapers during Covid, a mixed-method content analysis

Panic-buying and stockpiling during Covid disrupted the supply chain, causing food shortages and impacting the vulnerable. The government faced criticism for its lack of food system resilience, poor communications planning, and reliance on retailers. The British media frequently reported on panic-buying during early lockdown stages in 2020 and throughout Covid. The media play an important role in communicating information to the British public during times of crisis and influence public opinion. This mixed-method study examined English media portrayal of panic-buying, analysing text and visual data from six of the highest-circulating newspapers from March to July 2020. It reviewed reporting trends, use of imagery, themes, and prominent stakeholder voices. Content analysis of 209 articles showed that coverage was dominated by popular and left-wing press, with 89% of articles using sensationalised language and 68% coded as negative. In a subset of 125 articles, visual imagery showed empty shelves in 64% of analysed images, reinforcing the impression of food shortages. Supermarkets were the most quoted stakeholders, appearing in 62% of articles. Contradictions included reports of no food shortages alongside images of empty shelves and early newspaper advice encouraging stockpiling. Reporting peaked between March 16–22, 2020. Six key themes were identified: supermarket prominence, food supply/access, food policy, individual behaviour, socio-economic impacts, and panic-buying drivers—all themes had relevance to food system resilience. Future civil unrest linked to food-system challenges, potentially driven by climate change, conflict, or political instability, could see panic-buying play a significant role. Research on media portrayals of panic-buying can help policymakers enhance communication strategies and identify critical issues during crises. The Covid pandemic revealed crucial lessons about the media’s potential role in shaping public behaviour, highlighting the need for stronger government communication and collaboration with both the media and retailers to ensure consistent messaging, particularly to protect vulnerable groups.

Media technology is not the culprit: Factors influencing users’ quarrelsome behavior in political social platform use

Social platforms are seen as hotbeds of political debate, where squabbles between users with different views and positions have become commonplace. From the perspective of social cognition, this study considered the individual variables (degree of political firmness and political efficacy) and situation variables (news credibility and life satisfaction) synthetically to construct a structural equation model. The purpose of this study was to explore the factors influencing users’ quarrelsome behavior in political use on social platforms. The results show that users’ political firmness, the credibility of news in the media environment, and real-life satisfaction all contribute to their quarrelsome behavior on social platforms.

Morphological changes in the human mandible associated with the presence of exostoses: A cross-sectional study in two archaeological populations from southern France

This cross-sectional study aimed to investigate morphological changes in the human mandible in archaeological collections associated with the presence of bony exostoses at the mandibular angle, which is described in the literature as related to specific behaviours of the masticatory apparatus like parafunctional activities. The skeletal sample investigated comprised adult individuals from two archaeological series. Sixteen measurements of the mandible were selected to evaluate anatomic variation in the two populations. Mandibles from both series were pooled for statistical analysis into two groups according to the number of exostoses at the mandibular angles: group 1 (number of exostoses ≤1) and group 2 (number of exostoses ≥ 2). Measurements could be made on eighty mandibles. A statistically significant difference was demonstrated between group 1 and group 2 for the following parameters: distance between mandibular angles, bicondylar width, ramus height, left condyle length, and right and left coronoid process height. For each of these parameters, values were higher in group 2 than in group 1. This study presents an original methodology for studying anatomical variations of the mandible in the context of parafunctional activity, highlighting certain mandibular modifications. The impact of parafunctional behaviours such as bruxism on the mandible therefore has many anatomical expressions. The considerable variability of results found in the literature shows that more studies are needed to reach a consensus on the impact of parafunctional activities on the mandible.

Alleviating isolation stress in chickens: The benefits of home pen playback and mirrors

This study investigated whether the provision of (1) a mirror or (2) video and sound playback of conspecifics in the home pen (i.e., playback) could alleviate stress in socially isolated adult domestic chickens. Thirty adult chickens participated in the study, undergoing three-minute sessions of social isolation over three consecutive days in an arena containing a tray of food treats. Each chicken was exposed to three conditions, one per day, in a semi-randomised order: (1) mirror, (2) playback, and (3) control. Video recordings of the tests were coded for stress-related behaviours, including stress behaviour (i.e., pooled stress vocalisations and escape behaviour), vigilance, feeding, and exploration. Additionally, thermal imaging was used to measure the surface temperatures of the eye and comb. Social isolation elicited mild stress responses, as evidenced by reduced surface eye and comb temperatures along with the exhibition of stress and vigilance behaviours. Both playback and mirror conditions appeared to reduce stress behaviours compared to the control, although the effect of the mirror was not statistically significant. It is possible that the playbacks simulated the presence of a group of calm conspecifics. Vigilance behaviour, however, remained unaffected across conditions. These findings suggest that playback, and to a lesser extent mirrors, may alleviate certain stress-related behaviours in socially isolated adult chickens. As individual variation was high, future research should explore the role of individual differences in stress responses, as well as the long-term effects of repeated exposure to mirrors and playback, along with other environmental variables.

Towards high-quality development: The complex role of environmental regulation

High-quality development is a necessary condition for a healthy society, and environmental regulation is an important means to maintain high-quality development. Against this backdrop, this study takes the Yellow River Basin in China as an example to explore the complex impact of environmental regulation on high-quality economic development, with a particular focus on the indirect impact of regional pollution heterogeneity on the complex influence. Utilizing panel data from 2011 to 2022, this paper constructs an evaluation index system for the Yellow River Basin’s high-quality development that encompasses 29 fundamental indicators and applies the Entropy-Weighted TOPSIS method for a comprehensive assessment. The research found a significant positive relationship between environmental regulation and high-quality economic development, confirming the key role of environmental regulation in balancing economic growth and environmental protection. The article further analyzes the complex impact of environmental regulation under the background of pollution heterogeneity and discovers the nonlinear and threshold effect characteristics between environmental regulation and high-quality development. Notably, the positive influence of environmental regulation on high-quality economic development is already evident at lower intensities, yet becomes markedly more pronounced when the regulatory intensity reaches or exceeds a certain threshold. Additionally, the paper delves into the heterogeneous impacts of environmental regulation on high-quality economic development across regions with differing pollution levels. The findings indicate that in regions of severe pollution, the positive effect of environmental regulation is considerably more pronounced, potentially attributable to the heightened public concern for environmental issues and the stringent environmental protection measures implemented by the government. The study also addresses the issue of endogeneity using instrumental variable methods to ensure the robustness of the results. Ultimately, the paper presents targeted policy recommendations, including the formulation of region-specific environmental regulations, the establishment of regional collaborative governance mechanisms, the enhancement of public participation and oversight, and the promotion of green technological innovation, all aimed at fostering the coordinated advancement of high-quality economic development and environmental protection in the Yellow River Basin.

Understanding the Dynamics Governing Electrocatalytic Hydrodeoxygenation of Lignin Bio-Oil to Hydrocarbons

Influence of inspiratory muscle strength on 6-minute walk distance in patients with acute heart failure

Inspiratory muscle weakness may affect exercise tolerance; however, the relationship between inspiratory muscle strength and the 6-minute walk distance (6MWD) in patients with acute heart failure (AHF) is unknown. This study aimed to quantitatively investigate the association between inspiratory muscle strength at the start of cardiac rehabilitation (CR) and 6MWD at discharge in patients with AHF. This single-center, retrospective, observational study enrolled 275 patients with AHF who underwent CR. Patients unable to walk before admission, with isometric knee extensor strength/weight (%IKES) < 0.3 kgf/kg at the start of CR, or unable to undergo examination were excluded. Maximum inspiratory mouth pressure (PI-max) was used as an indicator of inspiratory muscle strength and was measured at the start of CR. The measured PI-max was divided by the predicted value and used for analysis (%PI-max). The primary outcome was 6MWD, an indicator of exercise tolerance, and was measured at discharge. Statistical analysis was performed using multiple regression analysis, with 6MWD at discharge as the dependent variable and %PI-max at the start of CR as the independent variable. Covariates were age, New York Heart Association class, physical frailty, and %IKES at the start of CR. The final analysis included 94 patients (median age 83.0 years, 57.5% male). Multiple regression analysis showed that %PI-max at the start of CR was significantly associated with 6MWD at discharge even after adjustment for covariates (β =  0.223, 95% confidence interval: 0.063–0.382, p =  0.007). PI-max was a factor associated with 6MWD at discharge in patients with AHF. In conclusion, increased inspiratory muscle strength may contribute to improved 6MWD in patients with AHF.

Recency and rarity effects in disambiguating the focus of utterance: A developmental study

While the communicator’s intended referent in a conversation may not be immediately apparent, effective communication often overcomes this ambiguity. However, the specific mechanisms through which children use various cues to pinpoint the referent remain unclear. The communicator determines what is salient from the receiver’s perspective. In return, the receiver identifies what the communicator identifies to be relevant for the receiver. The current study focused on two salient cues: rarity and recency, because rarity results in surprise and recency means a cue is more easily perceived and remembered. The current study investigated how adults and children aged 7–10 employ rarity and recency cues embedded in a series of events to clarify the referent intended by the communicator. Participants observed sequences comprising one rare and eight frequent events. An utterance, “Did you see that?” was presented at the end of each sequence, and participants identified the event(s) referred to by “that.” Events that were rare and close to the utterance were more likely to be identified as the referents. Notably, the utilization of these cues differed between adults and children. For adults, the recency effect manifested gradually, with events closer to the utterance identified more frequently, and it exhibited an interaction with rarity. Among children, the recency effect was absolute, as the event closest to the utterance held a higher likelihood of being identified, and this effect was not influenced by rarity. Two additional conditions eliminated potential response biases and memory-related confounds. Our research suggests that school-age children are capable of disambiguating utterances by factoring in that the events they find salient are likely to be the communicator’s focus. However, they are still in the process of developing reasoning skills similar to those of adults.

Bacterial profiles of the oral, vaginal, and rectal mucosa and colostrum of periparturient sows

The commensal microbiota influences the health, feeding efficiency, and reproductive performance of sows. The microbiota composition in the alimentary and genitourinary tracts and in colostrum/milk during pregnancy and lactation also impacts the microbiota and immune system, growth, and health of the piglets. Knowledge of the microbial compositions is important for evaluation of these effects and for discovering ways to improve the health and productivity of the sows. Oral, vaginal, and rectal mucosa and colostrum were sampled from 32 sows of variable parity in late pregnancy, and colostrum within 6 hours of delivery of the first piglet, on four commercial piglet-producing farms in Finland. Microbial compositions were analyzed by 16S rRNA gene amplicon sequencing. The most abundant genera of the oral microbiota were Rothia , Moraxella , and Streptococcus . The rectal microbiota was dominated by Clostridium sensu stricto 1 . Streptococcus was the most abundant genus in the vagina and colostrum. Moderate differences in diversity and composition were observed between farms. The relative abundances of the genera Neisseria (MaAsLin 2 q = 0.002, ANCOMBC q = 0.005), Fusobacterium (MaAsLin 2 q = 0.008, ANCOMBC q = 0.04) and Bacteroides (MaAsLin 2 q < 0.005, ANCOMBC q = 0.06) were lower in oral samples and Romboutsia (MaAsLin 2 q = 0.07, ANCOMBC q = 0.05), Turicibacter (MaAsLin 2 q = 0.08, ANCOMBC q = 0.02) and Lachnospiraceae_UCG_007 (MaAsLin 2 q = 0.1, ANCOMBC q = 0.05) were higher in rectal samples of multiparous compared to primiparous sows. In vaginal samples there was a tendency of higher relative abundances of the genera Fusobacterium and Streptococcus in multiparous than primiparous sows. Among the differentially abundant taxa, F . necrophorum and F . nucleatum were identified in oral samples, F . gastrosuis and F . necrophorum in vaginal samples, and S . dysgalactiae in colostrum samples. This study provides a comprehensive overview of the mucosal and colostrum microbiota of periparturient sows during normal production conditions on Finnish commercial farms.

Privatized healthcare for older adults living with chronic illness: A scoping review protocol for synthesizing the state of knowledge on their experiences

As global populations age, the prevalence of chronic illness among older adults is increasing, intensifying the burden on healthcare systems. Research shows that today’s older adults, especially those over 65, are more likely to suffer from multiple chronic conditions than previous generations. This demographic shift underscores the urgent need for healthcare systems capable of addressing complex, long-term health needs. The rise of privatized healthcare—services provided by non-governmental entities and funded through private insurance or out-of-pocket payments—has become a significant feature of the healthcare landscape, affecting how older adults receive care. In contrast to public healthcare systems, which are government-funded and aim to ensure universal coverage, privatized models often involve substantial private costs. Hybrid systems, such as those in Australia, combine public and private elements to offer comprehensive services. However, even in predominantly public systems like Canada, private costs for non-covered services persist. This scoping review protocol outlines a plan to identify (1) the potential role of privatized healthcare models in countries with public or hybrid healthcare in addressing health needs, (2) challenges and limitations associated with these models for older adults living with chronic conditions, and (3) current gaps in knowledge regarding the impact of privatized healthcare on care outcomes for older adults, based on the available literature.. It aims to explore the experiences and challenges of this population across various countries with public or hybrid healthcare systems. The review will use a structured methodology based on the Arskey and O’Malley guidelines and the Joanna Briggs Institute framework, focusing on qualitative studies published in the past 20 years. By comparing findings across different settings, the review seeks to provide a comprehensive understanding of how privatized healthcare models affect older adults and inform future research and policy development.

Fractal-fractional modeling and stability analysis of pine wilt disease dynamics

In this article, we have constructed a compartmental mathematical model employing fractal-fractional operators to investigate the dynamics of pine wilt disease. The model comprises six nonlinear ordinary differential equations, representing six compartments for individuals categorized as susceptible, exposed, and infected. Furthermore, we restructured the model by applying methodologies that are based on fractional calculus and fractal theory, one can gain significant insights into the intricacies of pine wilt disease transmission. The model’s essential properties, that is existence and uniqueness were analysed using the Banach and Leray-Schauder theorems. We study the stability of the fractional model by applying the Ulam-Hyers stability conditions. Additionally, computational techniques for the model in fractal-fractional cases are formulated using an iterative numerical approach like the fractional Adams-Bashforth methodology. Finally, we presented a comprehensive simulation conducted to validate the theoretical findings. The results are simulated to correspond to various fractional order values (θ1) and fractal dimensions (θ2) using MATLAB.

X under Musk’s leadership: Substantial hate and no reduction in inauthentic activity

Numerous studies have reported an increase in hate speech on X (formerly Twitter) in the months immediately following Elon Musk’s acquisition of the platform on October 27th, 2022; relatedly, despite Musk’s pledge to “defeat the spam bots,” a recent study reported no substantial change in the concentration of inauthentic accounts. However, it is not known whether any of these trends endured. We address this by examining material posted on X from the beginning of 2022 through June 2023, the period that includes Musk’s full tenure as CEO. We find that the increase in hate speech just before Musk bought X persisted until at least May of 2023, with the weekly rate of hate speech being approximately 50% higher than the months preceding his purchase, although this increase cannot be directly attributed to any policy at X. The increase is seen across multiple dimensions of hate, including racism, homophobia, and transphobia. Moreover, there is a doubling of hate post “likes,” indicating increased engagement with hate posts. In addition to measuring hate speech, we also measure the presence of inauthentic accounts on the platform; these accounts are often used in spam and malicious information campaigns. We find no reduction (and a possible increase) in activity by these users after Musk purchased X, which could point to further negative outcomes, such as the potential for scams, interference in elections, or harm to public health campaigns. Overall, the long-term increase in hate speech, and the prevalence of potentially inauthentic accounts, are concerning, as these factors can undermine safe and democratic online environments, and increase the risk of offline harms.