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Depressive symptoms, overweight/obesity, and ADHD from childhood to adolescence: a cross-cohort study of cultural and timing effects
No full textBackground:
Children who are persistently overweight/obese have a higher risk of ADHD symptoms. Comorbid ADHD increases psychosocial challenges that could worsen mental health problems in children with overweight/obesity. This study analyzed data from England and Hong Kong to examine whether, and why, comorbid ADHD and persistent overweight/obesity is associated with depressive symptoms during the transition into adolescence.
Methods:
Body mass index and ADHD symptoms were measured in childhood (T1) and early adolescence (T2) on 4340 participants of the Avon Longitudinal Study of Parents and Children (ALSPAC) in England and 184 individuals of the Healthy Kids cohort in Hong Kong. Depressive symptoms were also measured at T2. Moderated mediation analysis was conducted to examine whether early (T1 & T2) ADHD accounted for the association between persistent overweight/obesity (T1 & T2) and depressive symptoms at T2.
Results:
In Hong Kong, risk of depression in adolescence was highest among children with both conditions of early ADHD and persistent overweight/obesity. Also, persistent overweight/obesity was associated with depressive symptoms in adolescence only among children with early ADHD; and this was primarily explained by persistence of ADHD into adolescence (β = 1.66, 95 %CI [0.44, 3.36]). These findings were not replicated in the England cohort.
Conclusions:
In some cultural settings, persistent ADHD symptoms have the potential to exacerbate depressive symptoms in adolescence. Early detection and intervention of ADHD symptoms is crucial for promoting long-term mental well-being
Operational research approaches and mathematical models for kidney exchange: a literature survey and empirical evaluation
Full text linkKidney exchange is a transplant modality that has provided new opportunities for living kidney donation in many countries around the world since 1991. It has been extensively studied from an Operational Research (OR) perspective since 2004. This article provides a comprehensive literature survey on OR approaches to fundamental computational problems associated with kidney exchange over the last two decades. We also summarise the key integer linear programming (ILP) models for kidney exchange, showing how to model optimisation problems involving only cycles and chains separately. This allows new combined ILP models, not previously presented, to be obtained by amalgamating cycle and chain models. We present a comprehensive empirical evaluation involving all combined models from this paper in addition to bespoke software packages from the literature involving advanced techniques. This focuses primarily on computation times for 49 methods applied to 4,320 problem instances of varying sizes that reflect the characteristics of real kidney exchange datasets, corresponding to over 200,000 algorithm executions. We have made our implementations of all cycle and chain models described in this paper, together with all instances used for the experiments, and a web application to visualise our experimental results, publicly available
Global incidence of lip, oral cavity, and pharyngeal cancers by subsite in 2022
No full textCancers of the lip, oral cavity, and pharynx (LOCP) represent a substantial public health challenge worldwide. Using GLOBOCAN national estimates of incidence, detailed cancer registry data from Cancer Incidence in Five Continents, and population statistics from the United Nations, the authors report the distribution of new cases of LOCP cancers in 185 countries by sex in 2022. Age-standardized incidence rates were calculated. For countries lacking registry data, regional averages from high-quality registries were used to impute subsite-specific estimates. Worldwide, 758,000 people were diagnosed with LOCP cancers in 2022, with oral cavity cancer accounting for approximately 42% of cases, followed by oropharynx (19.3%), nasopharynx (15.9%), hypopharynx (11.4%), salivary gland (7.3%), and lip (4.2%) cancers. Oral cavity cancer was the most frequent LOCP subsite among women in 141 countries and among men in 93 countries, and incidence rates were highest in countries in South-Central Asia. Oropharyngeal cancer was the most frequent LOCP subsite among men in 44 countries and among women in five countries across Europe, Northern America, South America, Australia, and New Zealand. Nasopharyngeal cancer was the most common subsite among men in 39 countries and women in 23 countries, mainly in Northern Africa, Middle Africa, and Eastern and South-Eastern Asia. Rates of hypopharyngeal and salivary gland cancers were low globally, although the incidence burden was greater than that of lip cancer. The authors discuss incidence patterns in relation to disease etiology and the prospects of delivering effective cancer control measures, spanning primary prevention, early detection, cancer treatment, and survivorship
Experiences of adult informal caregivers in palliative care provision for persons with advanced cancer: a meta-synthesis
Full text linkContext:
Cancer diagnoses are increasing in Sub-Saharan Africa. Diagnoses often occur at a late stage in the disease, hampering the timely initiation of palliative care. The lack of formalized palliative care provision in the region results in informal caregivers assuming most of the caregiving roles for patients. This has considerable implications for informal caregivers.
Objectives:
This meta-synthesis seeks to explore how informal caregivers of persons living with advanced cancer have experienced palliative care provision in Sub-Saharan Africa.
Methods:
This study was guided by Hannes’ framework of meta-synthesis. A systematic search of MEDLINE, EMBASE, PsycInfo, Global Health, CINAHL, Web of Science, Scopus, and the Africa Index Medicus databases was conducted. Two authors independently performed the screening and extraction processes. Thematic synthesis guided the analysis and synthesis.
Results:
Fifteen studies were retained in the study. The synthesis yielded eight analytical themes: motivations for caregiving, roles of informal caregivers, challenges and barriers of informal caregiving, quality of informal caregiving, burden and price of informal caregiving, coping strategies of informal caregivers, recommendations for improving caregiving, and the paradox of end-of-life preparation and advanced planning.
Conclusion:
In Sub-Saharan Africa, informal caregivers provide the backbone of palliative care, often without preparation, resources, or formal support. Their roles are shaped by cultural expectations of family duty but constrained by poverty and limited health infrastructure. Strengthening caregiver training and integrating their contributions into developing formal palliative care systems are essential to improve outcomes for patients and families
Strengths and limitations of urinary sugar testing; an observational study of intestinal permeability and absorption in adults and children in Zambia and Tanzania with reference to mucosal biopsies
No full textBackground: Sugar-based permeability testing has been used to report changes in intestinal barrier function in clinical and public health research over five decades, but it is still uncertain what these tests measure at a cellular level.
Objective: We set out to correlate recoveries of lactulose, rhamnose, xylose, 3-O-methyl-D-glucose and the lactulose:rhamnose recovery ratio (LRR), and where possible compare with mucosal structure. All sugar testing employed consistent doses and duration of urine collection (3 hours).
Methods: Analysis of sugar recoveries in seven published and unpublished observational studies in adults and children with environmental enteropathy in Zambia and Tanzania over 24 years, alongside comparison with mucosal biopsy analysis in a subset in Zambia. In one of the biopsy studies, local healthy controls (n=13) contributed data.
Results: From seven studies we assembled a database of 1,461 lactulose-based tests; in 422 of these tests satisfactory morphometry of small intestinal biopsies was also available. Across all studies, lactulose recovery was strongly correlated with recoveries of rhamnose (Spearman’s ρ=0.64; P<0.0001), xylose (ρ=0.59; P<0.0001) and 3-O-methyl-D-glucose (ρ=0.57; P<0.0001). LRR was inversely correlated with epithelial surface area (ESA; ρ=-0.26; P=0.0001), and 3-O-methyl-D-glucose demonstrated the strongest positive correlation with ESA (ρ=0.19; P=0.007). Differences in LRR by sex and HIV serostatus were largely due to differences in rhamnose recovery. Statistical analysis was correlational and included linear and fractional polynomial regression models.
Conclusion: LRR does distinguish between healthy and enteropathic states. However, these data suggest that test sugars may all permeate through the intestinal epithelium through common pathways, not necessarily distinguishing between pore, leak or unrestricted pathways or transcellular absorption
Lucas Islands game in intermediate macroeconomics
No full textThe authors of this article demonstrate how Hazlett’s (1996) adaptation of the Lucas Islands model can be integrated into an intermediate macroeconomics course to strengthen student learning. In the classroom game, students act as workers making labor supply decisions under imperfect information about the aggregate price level, thus generating real-time data on forecasts and labor choices. A structured post-game lecture then uses these data to show how individual price-expectation errors produce a short-run supply relationship consistent with the Lucas supply curve. The instructor can use these results to connect theoretical predictions with empirical testing. The authors argue that this interactive approach is associated with greater confidence in macroeconomic modeling and self-reported understanding of theory while enhancing engagement with both theoretical and empirical aspects of macroeconomics
Fatigue behaviour of PEEK fabricated by material extrusion additive manufacturing
Full text linkThis study investigates the fatigue behaviour of polyether ether ketone (PEEK) fabricated via material extrusion additive manufacturing—specifically fused filament fabrication (FFF)—with an emphasis on the interactions between stress, frequency, and temperature. Tensile tests conducted across varying strain rates and temperatures reveal that increasing strain rate enhances tensile strength and Young’s modulus but reduces elongation, whereas increasing temperature lowers tensile strength and stiffness while increasing elongation. Guided by these insights, fatigue tests were performed under cyclic tension–tension loading with a stress ratio of 0.5 at a fixed frequency of 5 Hz to establish a stress–life (S–N) curve. Specimens sustained up to 1 million cycles at 75 MPa (88.3 % of tensile strength), with fatigue life decreasing at higher stress amplitudes. Additional tests at varying frequencies and temperatures further demonstrated reductions in fatigue life at higher frequency and elevated temperature. Compared to moulded PEEK, the fatigue performance of FFF-printed PEEK is degraded by process-induced defects that promote viscoelastic losses, interlayer plasticity, and self-heating, accelerating damage and failure. Fractography using scanning electron microscopy (SEM) revealed a combination of brittle and ductile failure modes, while micro-computed tomography (µCT) enabled visualization of inter-bead delamination within the printed microstructure. These results establish quantitative links between processing, microstructure, and fatigue life in 3D-printed PEEK, providing a foundation for component design and qualification in cyclically loaded, high-performance applications
Interventions to promote patient utilisation of cardiac rehabilitation
No full textRationale:
Clinical practice guidelines routinely recommend that cardiac patients participate in rehabilitation programmes as part of comprehensive
secondary prevention of heart disease. However, only a small proportion of these patients utilise rehabilitation across global health
systems. This is an update of a Cochrane review last published in 2019.
Objectives:
Primary objective:
To assess the effects of interventions provided to increase patient enrolmentin, adherence to, and completion of cardiac rehabilitation (CR)
for people with myocardial infarction (MI), with angina, following coronary artery bypass graG (CABG) surgery or percutaneous coronary
intervention (PCI), or with heart failure (HF) who were eligible for CR in an inpatient or outpatient setting.
Secondary objectives:
To assess intervention costs and associated harms with interventions intended to promote CR utilisation.
Search methods:
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library (Wiley), MEDLINE (Ovid), Embase (OVID),
CINAHL Cumulative Index to Nursing and Allied Health Literature (EBSCO), and Conference Proceedings Citation Index - Science (CPCI-S)
via Web of Science (Clarivate Analytics). We checked the reference lists of relevant systematic reviews for additional studies and searched
two clinical trial registers. We did not apply any language restrictions. The date of search was 02 March 2025.
Eligibility criteria:
We included randomised controlled trials (RCTs) and quasi-RCTs in adults with MI, with angina, undergoing CABG surgery or PCI, or with
HF who were eligible for CR in an inpatient or outpatient setting. Interventions had to aim to increase patient utilisation of CR, and we
included any study that aimed to increase patient enrolment in, adherence to, or completion of CR.
Outcomes:
Critical outcome measures were CR programme enrolment, CR programme adherence, and CR programme completion. Important
outcome measures included serious adverse events (SAEs) and costs.
Risk of bias:
We used the Cochrane RoB 1 tool to assess the risk of bias in eligible trials.
Synthesis methods:
One review author extracted trial data into piloted data extraction forms, which were checked by a second review author. We pooled
outcome data across included studies using random-effects meta-analysis, and used meta-regression to explore the potential impact of
prespecified intervention characteristics on intervention effects.
Included studies:
We included 47 studies (58 comparisons) with 10,803 participants. Trials were conducted over a range of geographical settings, principally
North America and Europe or other high-income economies. No studies from low- and middle-income country settings were included.
Participants in most of the included studies were primarily male. The median percentage of females across studies was 40% (range 0% to
100%). Sixteen studies included patients with HF. We assessed most studies as having low or unclear risk of bias.
Studies tested a variety of strategies to increase utilisation of CR. The most common intervention strategies tested were: education/selfmanagement training/motivational interviewing (nine trials); switch from traditional centre-based CR to alternative models of delivery -
home/digital/hybrid (eight trials); letters/messaging invites (seven trials); peer support strategies (five trials); women-only programmes
(two studies); and use of financial incentives (two studies).
Synthesis of results:
Interventions to promote patient utilisation of CR may increase programme enrolment (risk ratio (RR) 1.19, 95% confidence interval (CI)
1.11 to 1.29; 27 trials (31 comparisons), 7216 participants; low-certainty evidence). Meta-regression showed no evidence of significant
diFerences in prespecific trial-level covariates, except for the intervention target where there was weak evidence of somewhat higher
impact of interventions in trials where the intervention target was the patient.
Interventions to promote patient utilisation of CR likely increase programme adherence (standardised mean diFerence (SMD) 0.32, 95% CI
0.15 to 0.49; 18 trials (21 comparisons), 3024participants;moderate-certainty evidence).Meta-regression showedno evidence of significant
differences in prespecific trial-level covariates and the impact of interventions.
Interventions to promote patient utilisation of CR likely increase programme completion (RR 1.22, 95% CI 1.10 to 1.35; 19 trials
(23 comparisons), 5432 participants; moderate-certainty evidence). Meta-regression showed no evidence of significant diFerences in
prespecific trial-level covariates and the impact of interventions.
There was strong evidence of small study bias for enrolment, and weak evidence of small study bias for completion. There was no evidence
of small study bias for adherence.
There was likely no increase in the incidence of SAEs with interventions to promote utilisation of CR (RR 0.82, 95% CI 0.44 to 1.51; 6
trials (6 comparisons), 716 participants; moderate-certainty evidence). Little information (four trials) was available on the costs or costeFectiveness of interventions to promote utilisation of CR.
Authors' conclusions:
This updated Cochrane review shows that a range of interventions may increase utilisation of CR in terms of CR enrolment, and likely
increase CR adherence and completion. The certainty of the evidence was low to moderate due to high statistical heterogeneity across
trials, which was likely due to the range of included interventions and the diFerences in outcome collection and reporting
One-pot CRISPR-based point of care platform for rapid, specific and sensitive detection of HPV 16 without pre-amplification
Full text linkAccurate detection of gene subtypes with high sequence similarity is critical for pathogen diagnosis. Current CRISPRbased PCR diagnostics methods may provide improved specificity but rely on pre-amplification in a separate reaction, due to Cas protein thermal instability, increasing cross contamination. Here, we developed CRISPR-based terminalspecific amplification (CASTSA), a one-pot platform which makes use of the CRISPR-Cas12a specific recognition and cleavage, generating a single strand digested product with specific5’ termini, to serve as the template for qPCR amplification. Our assay simplifies sample preparation by eliminating the need pre-amplification, whilst simultaneously fully exploiting the high specificity of the CRISPR system and high sensitivity of PCR. CASTSA was validated in vitro and with clinical samples collected from individuals with Human Papillomavirus (HPV), demonstrating high specificity for HPV 16, whilst discriminating HPV 18, 33, 45, and 52 sub-types, using a laser-induced graphene (LIG)-based electrochemical sensor platform. The technique achieved a limit of detection of 18 copies/reaction and offers a robust and reproducible, one-pot solution for pathogen subtyping, providing excellent specificity, so advancing nucleic acid detection with an assay that is easier to implement when compared with standard clinical diagnostic workflows
Data sources:
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