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When Do Individuals Believe in Themselves Rather Than in Artificial Intelligence? Insights from Longitudinal Investigations in Corporate Credit-Rating Contexts
No full textIndividuals often prioritize their own judgements rather than heeding the advice of artificial intelligence (AI). This study draws on the literature on anchoring theory and cognitive biases to explore the theoretical mechanisms underlying individuals' reliance on AI advice and how this reliance affects decision performance. Specifically, we examined situations in which (1) individuals' knowledge accumulated over time, (2) multiple information sources were available, and (3) AI could emulate users' decisions. We developed a 'corporate credit-rating' AI system that could provide more accurate advice than users. We then conducted two main longitudinal studies and four supplementary ones - six in total - with each study comprising three sessions. Our findings demonstrated that individuals' initial estimates became more similar to AI advice over time. As the difference between individuals' initial estimates and AI advice increased, individuals were more inclined to revise their initial judgements but showed lower relative dependence on AI. This effect, however, depended on the individuals' experience in decision-making. Additionally, introducing additional information reduced the similarity between the initial estimate and AI advice, but the proximity of additional information to AI advice facilitated individuals' adjustment to the advice. We discuss the theoretical and practical implications of these results
Individual hearts:computational models for improved management of cardiovascular disease
No full textCardiovascular disease remains a leading cause of morbidity and mortality worldwide, with conventional management often applying standardised approaches that struggle to address individual variability in increasingly complex patient populations. Computational models, both knowledge-driven and data-driven, have the potential to reshape cardiovascular medicine by offering innovative tools that integrate patient-specific information with physiological understanding or statistical inference to generate insights beyond conventional diagnostics. This review traces how computational modelling has evolved from theoretical research tools into clinical decision support systems that enable personalised cardiovascular care. We examine this evolution across three key domains: enhancing diagnostic accuracy through improved measurement techniques, deepening mechanistic insights into cardiovascular pathophysiology and enabling precision medicine through patient-specific simulations. The review covers the complementary strengths of data-driven approaches, which identify patterns in large clinical datasets, and knowledge-driven models, which simulate cardiovascular processes based on established biophysical principles. Applications range from artificial intelligence-guided measurements and model-informed diagnostics to digital twins that enable in silico testing of therapeutic interventions in the digital replicas of individual hearts. This review outlines the main types of cardiovascular modelling, highlighting their strengths, limitations and complementary potential through current clinical and research applications. We also discuss future directions, emphasising the need for interdisciplinary collaboration, pragmatic model design and integration of hybrid approaches. While progress is promising, challenges remain in validation, regulatory approval and clinical workflow integration. With continued development and thoughtful implementation, computational models hold the potential to enable more informed decision-making and advance truly personalised cardiovascular care
Revascularisation strategies for non-acute myocardial ischaemic syndromes
No full textBackground Contemporary guidelines by the European Society for Cardiology and American College of Cardiology/American Heart Association for the treatment of non-acute myocardial ischaemic syndromes dispute the value of revascularisation and differ in their recommendation to perform revascularisation. A Bayesian network meta-analysis was performed, evaluating the strength of evidence for the comparative incremental effectiveness of coronary artery bypass grafting (CABG) versus percutaneous coronary intervention (PCI) over medical therapy on long-term outcomes. Methods A hierarchical Bayesian network meta-analysis was designed (PROSPERO CRD42024541215, date 20 May 2024), including randomised controlled trials (RCTs) published between 2005 and 10 June 2025, which consisted of three initial treatment modalities: optimal medical therapy (OMT), PCI+OMT and CABG+OMT. The primary outcome was all-cause mortality at maximum follow-up; secondary outcomes were trates of the rates of myocardial infarction, stroke and re-revascularisation at maximum follow-up, expressed in HRs and 95% credible intervals (CrIs), accompanied by surface under the cumulative ranking curve (SUCRA) scores. Results 10 RCTs, comprising 10 742 patients, were included. For all-cause mortality, the estimated median HR of CABG+OMT versus OMT was 0.84 (95% CrI 0.68–1.07); the HR of PCI+OMT versus OMT was 0.93 (0.79–1.16); and the HR of CABG+OMT versus PCI+OMT was 0.91 (0.71–1.13). The SUCRAs of a CABG+OMT strategy ranking as the optimal revascularisation treatment regarding mortality, myocardial infarction, stroke and re-revascularisation were 88.1%, 99.7%, 17.5% and 99.5%, respectively. Results were consistent across sensitivity analyses, including in the node-splitting models. Conclusions This Bayesian network meta-analysis found that an initial CABG (+OMT) revascularisation strategy was associated with higher probabilities of optimal outcomes, with the exception of stroke, compared with an initial PCI (+OMT) revascularisation strategy, although CrIs overlapped, suggesting that some uncertainty remains.</p
Updated LIfestyle for BRAin health (LIBRA2) Score, Genetics, and Risk of Alzheimer Disease, Vascular Dementia, and Stroke in Older Adults
No full textBackground and ObjectivesDementia and stroke are major global causes of disability, with modifiable lifestyle factors playing a significant role in their development. The updated LIfestyle for BRAin health (LIBRA2) score integrates 15 modifiable risk and protective factors to quantify lifestyle-based dementia risk, but its relationship with stroke and dementia subtypes remains unexplored. We investigated LIBRA2's association with stroke and dementia subtypes while also assessing potential interactions with genetic susceptibility.MethodsProspective data were used from the French multicenter Three-City (3C) Study, with participants aged 65 years and older followed for up to 17 years. Weighted LIBRA2 scores at baseline were constructed based on the presence of 15 modifiable risk and protective factors, with higher scores representing higher lifestyle-based dementia risk. Cox proportional hazards models were used to study the association of LIBRA2 with incident dementia (and subtypes) and stroke, adjudicated by expert neurologist panels. Genetic susceptibility to dementia and stroke was assessed using APOE epsilon 4 carriership and disease-specific genetic risk scores.ResultsAnalyses included 4,731 participants for stroke (mean age 73.8 years, 60.1% female) and 4,737 participants for dementia (mean age 73.8 years, 59.9% female). One-point increases in LIBRA2 scores (theoretical range -6.1 to +25.7) were associated with increased dementia risk (hazard ratio [HR] 1.08; 1.06-1.11), with a stronger association for vascular and mixed dementia (HR 1.13; 1.08-1.18) compared with Alzheimer disease (AD) dementia (HR 1.06; 1.03-1.09). LIBRA2 was not significantly associated with incident stroke risk (HR 1.03; 0.99-1.07). No significant interaction was found between LIBRA2 and APOE epsilon 4 carriership or disease-specific genetic risk scores in relation to dementia subtypes or stroke.DiscussionLIBRA2 serves as a valuable tool for assessing lifestyle-related dementia risk and its subtypes but showed no association with stroke, highlighting the potential for a stroke-specific risk reduction model. These associations were independent of genetic disease susceptibility, reinforcing the universal benefits of lifestyle modifications on dementia risk reduction. The stronger association between LIBRA2 (and some individual components) and vascular or mixed dementia, compared with AD dementia, highlights the pivotal role of vascular mechanisms in the relationship between lifestyle and brain health
Malignant pleural mesothelioma classification and survival prediction with CT imaging using ResNet
No full textObjectives: This study aims to achieve accurate differentiation of malignant pleural mesothelioma (MPM) from metastatic pleural disease (MPD) and to predict the overall survival of MPM. Materials and methods: This IRB-approved retrospective study included 385 subjects in total (85 patients with malignant mesothelioma and 290 with MPD secondary to lung adenocarcinoma). A ResNet-3D-18 model was trained on annotated pretreatment CT scans to distinguish MPM from MPD. Using chronological segregation, the training cohort included 70 histologically confirmed mesothelioma and 258 MPD cases, with an independent test cohort of 15 MPM and 32 MPD cases for validation. A multivariate logistic regression model served as the clinical benchmark for comparison. Deep learning features extracted from the trained ResNet model were then assessed for their prognostic utility in MPM patients using a random forest classifier. Model performance was evaluated at both lesion- and patient-levels, with metrics including the area under the ROC curve (AUC), accuracy, sensitivity, specificity, positive predictive value, and negative predictive value. Results: The ResNet-3D-18 model demonstrated excellent discriminative performance in differentiating MPM from MPD, with mean AUCs of 0.972 (95% CI 0.947–0.990) and 0.840 (95% CI 0.757–0.929) in the training and independent test cohorts. Compared to the clinical model, the deep learning approach showed higher sensitivity (0.867 vs. 0.533) in the independent test dataset. For overall survival prediction in MPM patients, the random forest classifier achieved an AUC of 0.829 (95% CI 0.663–0.943) in 5-fold cross-validation. Conclusions: ResNet-3D-18 classification model has excellent abilities in differentiating MPM from MPD, and morphological distinctions between MPM and MPD also contain prognostic information. Key Points: Question The rising global incidence of malignant pleural mesothelioma contrasts with persistent diagnostic challenges. Findings Deep learning-derived discriminative features simultaneously contain prognostic information. Clinical relevance This study bridges the gap between radiological findings and clinical decision-making in MPM, offering a reproducible tool for early diagnosis and personalized prognosis prediction based on CT imaging alone.</p
Introduction: the 2022 Russian invasion of Ukraine and the re-making of the European security order
No full textRussia’s increasing aggression, the return of great power rivalry, and eventually the 2022 invasion of Ukraine have brought back questions about Europe's security order. In response to Russia’s war against Ukraine, both states and security organisations–the EU and NATO–have implemented new policies to address Europe’s vulnerabilities and to support Ukraine politically and militarily. This introduction to this special issue serves two purposes. First, it explores the war, examining debates on the origins of the war and tracing the evolution of the war to summer 2025. Second, it places the war in the context of longer-term debates on European security order, arguing that a largely liberal European security order was consolidated after the Cold War, but that relations between Russia and the West remained partly characterised by more traditional realist dynamics. The articles in this special issue explore how far and in what ways Russia’s full-scale war against Ukraine since 2022 can be viewed as a critical juncture for Europe’s security order, resulting in major and lasting changes to that order. Taken together, the articles highlight that while February 2022 may have been a turning point, the impacts of the war vary in important ways across states and institutions.</p
Frequency and survival of delayed breast cancer diagnosis in women participating at screening mammography in the Netherlands:a population-based study
No full textBackground Although breast cancer screening programmes aim to enable early breast cancer detection, diagnostic delays still occur among participants. Limited information is available on the frequency and survival of women with a delay in breast cancer diagnosis within the screening population. We determined the frequency of various types of delay in breast cancer diagnosis at screening mammography and specified the tumour characteristics, surgical therapy and survival rates of women with these delayed diagnoses, as well as variations in their proportions over time. Methods We included 901,133 screening examinations obtained in the southern Netherlands between 1999 and 2019. Screening mammograms of women with interval cancers (ICs) and breast cancers detected at subsequent screening were reviewed to determine whether the cancer had been missed. Findings Of the 7129 women with breast cancers, 5419 (76.0%) were diagnosed without delay after recall and 1101 (15.4%) had a true IC (i.e., not detectable at the previous screen). In total, 1601 women experienced a delay in breast cancer diagnosis, comprising the following three study groups: (i) recalled women with a delay in diagnostic work-up (n = 264), (ii) recalled women with screen-detected cancers (SDCs) at subsequent screening and without a delay in diagnostic work-up, that had been missed at the previous screening round (n = 992), and (iii) women with ICs missed at the latest screening round (n = 345). Overall, 26.6% of cancers were associated with a delay (1601/6028), primarily due to SDCs missed at the previous screen (62.0%, 992/1601), followed by missed ICs (21.5%, 345/1601) and misdiagnosis after recall (16.5%, 264/1601). Compared to SDCs missed at the previous screen and misdiagnosis after recall, missed ICs demonstrated the poorest tumour characteristics, highest mastectomy rate (42.6% vs 20.1% and 19.3%, p < 0.0001) and poorest overall survival (5-year rate 86.9% vs 93.8% and 93.8%, p = 0.0017). Temporal trends in tumour characteristics were mainly observed in SDCs missed at the previous screen. Interpretation Delayed breast cancer diagnosis at screening mammography or after recall remains a serious point of concern. Most delays are related to SDCs missed at a previous screen, whereas missed ICs show the worst survival. Funding This research did not receive any funding. Copyright (c) 2025 The Authors. Published by Elsevier Ltd. This is an open access article under the CC BY license (http://creativecommons.org/licenses/by/4.0/). Health 2026;61: Published https://doi.org/10. 1016/j.lanepe.2025. 10152
Housing in progress:Caring for and living in unfinished remittance houses
No full textEmpty, unfinished, or ‘ghost’ houses are common sights around the world, where aspirational investment in housing outpaces the potential to physically occupy it. While these structures may be only partially completed, this does not mean they are unoccupied. In fact, their state of incompleteness can prompt owners to find an occupant, in order to prevent incursion, protect the existing investment in construction, and enable incremental progress towards completion. This paper explores one configuration of housing investment – ‘remittance houses’, constructed by migrants – and the dynamics of caretaking and guardianship that arise to protect these housing structures while they are in-process over an unpredictable, multiple-year timeline. Building on two case studies, in Morocco and Ghana, we investigate both the lives of the houses in-progress and the accommodations and adaptations made by live-in caretakers to make them into dwell-able homes. These simultaneous and interwoven timelines involve uncertain futures for both the house and its occupants, as the more ‘complete’ the house becomes, the more uncertain the caretaker's tenure. We bring into question how the framework of ‘care’ as mutually transformative development can help to understand the affective and embodied investments made by the migrant who is building the home and the caretaker occupying and adapting it, in relation to the material responsiveness of the house itself. We take these mutual transformations as resonant not just for these houses which are markedly ‘unfinished’, but as a way to consider how much housing is somehow ‘in progress’ and complexly constituted through care
