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Leveraging artificial intelligence tools and resources in leadership decisions
No full textHealthcare leaders are continually making choices and solving complex problems that require thoughtful and timely decisions. Traditional decisions were based on a combination of experience, professional judgment, and strategic application of decision-making techniques. While these foundational approaches remain relevant, the rapidly evolving technological landscape with the emergence of artificial intelligence (AI), is introducing new opportunities and challenges for 21st-century leadership.
To deliberately proactively lead in the 21st century, leaders must incorporate AI tools and digital resources into decision-making processes to enhance the efficiency and effectiveness of their operations. This will improve the overall quality and impact of management decisions. Leveraging AI to analyze large datasets, predict trends, and generate evidence-based recommendations will reduce human bias, promote greater equity, and make more data-driven and analytically sound choices that are timely and responsive to evolving needs.
However, the integration of AI is not without ethical complexities. Systematic errors, algorithmic biases, cost and human resources barriers, and data limitations can inadvertently perpetuate or even exacerbate existing inequalities, particularly among vulnerable populations. Leaders must cultivate a new set of leadership competencies – ones that include AI and digital literacy, critical thinking, and ethical reasoning. They must develop these skills to understand how best to harness AI transformative benefits.
The future of effective leadership lies in the ability of leaders to balance traditional wisdom with technological innovation. Moving forward, we propose the ABC of AI-inclusive Decision-Making Process. This process will help leaders navigate AI complexities to make informed, equitably sound, clinical outcome-oriented, and impactful decisions in an increasingly data-driven world
Mitigating antimicrobial resistance by innovative solutions in AI (MARISA): a modified James Lind Alliance Analysis
No full textAntimicrobial resistance (AMR) is a critical global health threat and artificial intelligence (AI) presents new opportunities for our response. However, research priorities at the AI-AMR intersection remain undefined. This study aimed to identify and prioritise key areas for future investigation. Using a modified James Lind Alliance approach, we conducted semi-structured interviews with eight experts in AI and AMR between February and June 2024. Analysis of 338 coded responses revealed 44 distinct themes. Major barriers included fragmented data access, integration challenges and economic disincentives. The top ten priorities identified were: Combination Therapy, Novel Therapeutics, Data Acquisition, AMR Public Health Policy, Prioritisation, Economic Resource Allocation, Diagnostics, Modelling Microbial Evolution, AMR Prediction and Surveillance. A notable limitation was the underrepresentation of data from high-burden regions, limiting the generalisability of findings. To address these gaps, we propose the novel BARDI framework: Brokered Data-sharing, AI-driven Modelling, Rapid Diagnostics, Drug Discovery and Integrated Economic Prevention
Parental health literacy, dyadic adjustment, and joint decision-making: reframing parental antibiotic use in the 'superbug' era
No full textTemperatures of Jupiter’s upper atmosphere: the role of the planetary magnetic field
No full textThe primary source of heating in the upper atmospheres (thermospheres) of giant planets has been the subject of long debate. The conundrum (or “energy crisis”) consists in observed thermosphere temperatures at low and midlatitudes exceeding values expected from solar heating by several hundred kelvins, suggesting the presence of another energy source. Several theories have been proposed to explain the high temperatures, from heating by upward-propagating gravity or acoustic waves to heating of auroral regions by magnetosphere–atmosphere coupling. While auroral heating provides sufficient energy, the problem becomes one of global energy redistribution. On a rapidly rotating planet, Coriolis forces act to “trap” auroral energy in the polar regions, heating up the poles but leaving the equator cold. On Saturn, the redistribution of energy from poles to equator was recently achieved by invoking Rayleigh drag, possibly related to atmospheric gravity or acoustic waves. Using a new general circulation model of Jupiter, we reproduce well the observed low and midlatitude thermosphere temperatures without the need to invoke Rayleigh drag. Instead, the planet’s magnetic field is strong enough to cause significant ion drag and slowing down zonal winds in the nonauroral thermosphere and allow global energy redistribution. This distinguishes Jupiter from Saturn and most likely the other gas giant planets in our solar system may have implications on extrasolar planets with strong magnetic fields as well
Global incidence of female birdsong is predicted by territoriality and biparental care in songbirds
No full textPronounced sexual dimorphism is generally assumed to evolve through sexual selection for elaborate male traits. However, there is increasing evidence that sexual dimorphism in traits such as birdsong may also evolve through loss of elaboration in females, but the evolutionary drivers underlying this process are obscure. Here we analyse ecological and natural history traits for over 1300 songbird species and show that increased female song incidence and elaboration are most directly associated with year-round territoriality, biparental care, and large body size. Phylogenetic path analysis indicates that mating system and breeding latitude primarily have indirect effects on female song evolution. Stable, tropical life histories and mating systems with biparental care promote female song, whereas evolutionary transitions to migration, reduced territoriality, and loss of male care led to losses or reductions of female song incidence. Our analyses provide a comprehensive framework for studying the drivers of sex differences and similarities in birdsong and reveal novel interactions among natural history and sexual selection pressures that have been hypothesized to independently shape elaborate traits
Threat reduction must be coupled with targeted recovery programmes to conserve global bird diversity
No full textAmbitious international commitments have been made to preserve biodiversity, with the goal of preventing extinctions and maintaining ecosystem resilience, yet the efficacy of large-scale protection for preventing near-term extinctions remains unclear. Here, we used a trait-based approach to show that global actions—such as the immediate abatement of all threats across at least half of species ranges for ~10,000 bird species—will only prevent half of the projected species extinctions and functional diversity loss attributable to current and future threats in the next 100 years. Nonetheless, targeted recovery programmes prioritizing the protection of the 100 most functionally unique threatened birds could avoid 68% of projected functional diversity loss. Actions targeting ‘habitat loss and degradation’ will prevent the greatest number of species extinctions and proportion of functional diversity loss relative to other drivers of extinction, whereas control of ‘hunting and collection’ and ‘disturbance and accidental mortality’ would save fewer species but disproportionately boost functional richness. These findings show that conservation of avian diversity requires action partitioned across all drivers of decline and highlight the importance of understanding and mitigating the ecological impacts of species extinctions that are predicted to occur even under optimistic levels of conservation action
Power structures on the Grothendieck–Witt ring and the motivic Euler characteristic
No full textFor k a field, we construct a power structure on the Grothendieck–Witt ring of k which has the potential to be compatible with symmetric powers of varieties and the motivic Euler characteristic. We then show our power structure is compatible with the variety power structure when we restrict to varieties of dimension 0, using techniques of Garibaldi, Merkurjev and Serre about cohomological invariants
Marangoni-driven patterns, ridges and hills in surfactant-covered parametric surface waves
No full textParametric oscillations of an interface separating two fluid phases create nonlinear surface
waves, called Faraday waves, which organise into simple patterns, such as squares and
hexagons, as well as complex structures, such as double hexagonal and superlattice
patterns. In this work, we study the influence of surfactant-induced Marangoni stresses
on the formation and transition of Faraday-wave patterns. We use a control parameter,
B, that assesses the relative importance of Marangoni stresses as compared with the
surface-wave dynamics. Our results show that the threshold acceleration required to
destabilise a surfactant-covered interface through vibration increases with increasing B.
For a surfactant-free interface, a square-wave pattern is observed. As B is incremented, we
report transitions from squares to asymmetric squares, weakly wavy stripes and ultimately
to ridges and hills. These hills are a consequence of the bidirectional Marangoni stresses
at the neck of the ridges. The mechanisms underlying the pattern transitions and the
formation of exotic ridges and hills are discussed
Early ezetimibe initiation after myocardial infarction protects against later cardiovascular outcomes in the SWEDEHEART registry
No full textBackground
Combination lipid-lowering therapy (LLT) after myocardial infarction (MI) achieves lower low-density lipoprotein cholesterol (LDL-C) levels and better cardiovascular outcomes vs statin monotherapy. As a result, global guidelines recommend lower LDL-C but, paradoxically, advise treatment through a stepwise approach. Yet the need for combination therapy is inevitable as <20% of patients achieve goals with statins alone. Whether combining ezetimibe with a statin early vs late after MI results in better outcomes is unknown.
Objectives
In this study, the authors sought to assess the impact of delayed treatment escalation on outcomes by comparing early vs late oral combination LLT (statins plus ezetimibe) in patients with MI.
Methods
LLT-naïve patients (SWEDEHEART registry) hospitalized for MI (2015-2022) and discharged on statins were included. Using clone-censor-weight and Cox proportional hazards models, we compared differences in risks of MACE (death, MI, stroke), components of MACE, and cardiovascular death between patients with ezetimibe added to statins ≤12 weeks after discharge as reference (early combination therapy), from 13 weeks to 16 months (late combination therapy), or not at all.
Results
Of 35,826 patients (median age 65.1 years, 26.0% women), 6,040 (16.9%) received ezetimibe early, 6,495 (18.1%) ezetimibe late, and 23,291 (65.0%) received no ezetimibe. High-intensity statin use was ≥98% in all groups. Over a median 3.96 years (Q1-Q3: 2.15-5.81 years), 2,570 patients had MACE (440 cardiovascular deaths). One-year MACE incidences were 1.79 (early), 2.58 (late), and 4.03 (none) per 100 patient-years. Compared with early combination therapy, weighted risk differences in MACE for late combination therapy at 1, 2, and 3 years were 0.6% (95% CI: 0.1%-1.1%; P < 0.01), 1.1% (95% CI: 0.3%-2.0%; P < 0.01), and 0.7% (95% CI: −0.2% to 1.3%; P = 0.18), and 3-year HR was 1.14 (95% CI: 0.95-1.41). For those receiving no ezetimibe, risk differences were 0.7% (95% CI: 0.2%-1.3%), 1.6% (95% CI: 0.8%-2.5%), and 1.9% (95% CI: 0.8%-3.1%; P for all <0.01; 3-year HR: 1.29 [95% CI: 1.12-1.55]). Similar differences in risk of cardiovascular death at 3 years were observed (HRs vs early: late: 1.64 [95% CI: 1.15-2.63]; none: 1.83 [95% CI: 1.35-2.69]).
Conclusions
MI care pathways should implement early combination therapy with statins and ezetimibe as standard care, because delaying use of combination LLT or using high-intensity statin monotherapy is associated with avoidable harm
A survey exploring people's experiences with lithium bought as a supplement: une enquête sur l’expérience des personnes avec le lithium en supplément
No full textObjective
Lithium, despite its evidence base and range of indications, is often underutilized due to safety concerns associated with high-dose prescriptions and consequent necessity for regular blood monitoring. Emerging evidence suggests its potential benefits at lower doses, especially for its pro-cognitive effects and positive safety profile. While accessible as a supplement, empirical human evidence on neuropsychiatric effects is lacking. This study aimed to provide preliminary evidence regarding the utilization and perceived effects of low-dose lithium supplements (LiS) in the community.
Methods
Cross-sectional, opportunistic survey of 211 participants aged ≥18 years who disclosed taking over-the-counter lithium supplements. The survey assessed sample demographics, supplement details, overall perspectives, and personal experiences related to the use of LiS.
Results
The most common form of LiS taken was aspartate at 10 mg once per day, although lithium orotate and ionic lithium were also frequently used. The most common beliefs regarding the benefits of using lithium as a supplement concern efficacy for anxiety, but the most common improvements experienced was in the domain of cognition, closely followed by anxiety and mood. Mood was most commonly reported as the greatest improvement. Side effects and withdrawal phenomena were more prevalent than anticipated.
Conclusion
This study revealed a diverse range of lithium supplements taken, in terms of dosage, formulation, frequency, and duration of intake. Anecdotal evidence highlighted prevalent perceived benefits and adverse effects. The study is, however, limited notably by its cross-sectional opportunistic design; more robust evidence, especially from controlled trials, is needed to fully establish the specific benefits and drawbacks associated with different forms and doses of accessible lithium supplements