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From the Lab to the ICU:Video-Based Facial Pain Assessment Using a Differential Multiple Instance Learning Network
No full textPain is a stressor for intensive care unit (ICU) patients, and inadequate pain assessment has been linked to increased morbidity and mortality. Machine learning has demonstrated potential in assisting pain assessment. However, most studies on automated facial pain assessment have primarily been limited to laboratory subjects, with only a few targeting hospitalized infants. They are less practical because ICU patients are primarily older adults, and individual variations in illness and pain threshold can lead to long-term and short-term pain expressions. Furthermore, the texture of aging skin and reduced facial muscle elasticity make it challenging to capture pain expression features. To address these challenges, we present an efficient, weakly supervised approach that models video-based facial pain assessment as a multiple-instance learning problem. Specifically, we introduce a new large-scale Intensive Care Unit Pain Expression Dataset (ICUPED), which contains 714 facial videos from 152 ICU patients (mean age: 62.9 years). We propose a novel differential multiple instance pain assessment network (DMI-PAN) with a differential learning module (DLM). The network preserves the raw pain information from video snippets via uniform sampling and fine-grained instance partitioning. The DLM uses a pretrained coarse classifier to distinguish long-term from short-term pain expressions. It also models facial pain motion to capture dynamic pain information, thereby reducing individual facial variations. In comparison with other techniques, the proposed method achieved state-of-the-art (SOTA) results on both the ICUPED dataset and the publicly available UNBC-McMaster Shoulder Pain Archive dataset, improving the accuracy of the ICUPED low-level and high-level pain classification tasks by 11.1% and 5.2%, respectively. The results demonstrate the promising potential of the developed DMI-PAN model for automating the process of pain assessment in ICU settings.</p
High-Order CSK Realization for MC via Spatially Distributed Multicellular Consortia
Get PDFProgress in molecular communication (MC) relies on the development of novel and efficient signal processing mechanisms. Synthetic biology meets this need by allowing precise control over intracellular signaling and molecular exchange in engineered cells, enabling engineered signal processing tasks within living networks. Facilitated by this advancement, we design and engineer multicellular consortia with spatial segregation to realize an octuple concentration shift keying (8-CSK) transceiver—covering both modulation and demodulation—in a fully biological framework using simple and reusable single-input single-output cells. The proposed design demonstrates the scalability of our framework while maintaining the advantages of distributed computation, minimal genetic manipulation, and signal orthogonality. Additionally, we derive the mathematical framework of 8-CSK based on modular building blocks, enabling an accurate theoretical characterization of the system. Simulation results from the agent-based simulator—BSim—validate the feasibility of our extended design and demonstrate strong agreement with the theoretical analysis, highlighting the robustness and applicability of our CSK framework to higher-order modulation schemes.</p
Efficacy and safety of external phytotherapy in diabetic foot ulcers: a GRADE-assessed systematic review and meta-analysis of randomized controlled trials
No full textBackgroundDiabetic Foot Ulcers (DFUs) represent a global healthcare challenge, imposing substantial socioeconomic burdens due to their increasing incidence and associated mortality. This study evaluates the efficacy and safety of external phytotherapy (utilizing various plant-derived compounds, including Chinese herbal medicines and plant-derived liposomes, administered topically) for the treatment of DFUs.MethodsRelevant studies were identified from major electronic databases (PUBMED, EMBASE, WOS, and the Cochrane Library) that were searched up to April 30, 2024. Randomized controlled trials (RCTs) that evaluated the effects of external phytotherapy for DFUs. The treatment group was treated with external phytotherapy plus conventional treatment, while the control group received conventional treatment alone. Two evaluators independently screened and selected literature, extracted data, and assessed the risk of bias. The outcome measures included complete ulcer healing, ulcer improvement, ulcer area reduction, and healing time. Weighted mean difference (WMD), standardized mean difference (SMD), and relative risk (RR) with 95% confidence intervals (CI) were used for data analysis. Heterogeneity was quantified using I² statistics, with appropriate application of fixed-effects or random-effects models. Methodological quality was ensured through Review Manager and Stata software, complemented by GRADE evidence assessment.ResultsTwenty studies with a total of 1,854 participants were identified. Our analysis suggested that compared with conventional treatment, external phytotherapy significantly enhances complete ulcer healing (RR: 1.84; 95% CI: 1.55 to 2.19), promotes ulcer improvement (RR: 1.32; 95% CI: 1.11 to 1.57), reduces ulcer area (WMD: -1.14; 95% CI: -1.45 to -0.83), and accelerates healing time (WMD: -3.93; 95% CI: -7.48 to -0.39). Safety profiles and ulcer depth measurements showed no significant intergroup differences. GRADE assessments indicated high-certainty evidence for most primary outcomes, whereas the evidence for percentage ulcer reduction was of low certainty due to serious inconsistency and imprecision.ConclusionExternal phytotherapy demonstrates potential as an adjunctive treatment for diabetic foot ulcers, improving primary outcomes like complete healing with moderate to high certainty of evidence. Nevertheless, regional bias—with most evidence derived from East Asia—warrants caution in generalizing these results. Further rigorous, multi-regional trials are needed to solidify the evidence base and refine clinical application.<br/
Firm climate investment:A glass half-full
Get PDFThe green transition will require large investments from firms, yet little is known about the scale and drivers of climate-related capital expenditure across the UK economy. To address this gap, we draw on a large, representative survey of UK firms to quantify how businesses expect to adjust their medium-term investment in response to climate change. Over 2023-2026, firms expect climate-related investments to account for 5.5% of total capital expenditure. These investments will be driven by larger firms as well as those in more energy-intensive sectors. The main channels for these investments are switching to green energy sources and improving energy efficiency, and firms plan to finance them primarily using internal cash reserves. Overall, although firms are expecting to invest more resources in adapting to climate change, under reasonable assumptions, these investments are still not sufficient to meet the estimated targets implied by the UK Net Zero Pathway.</p
<i>The News Agents</i>: “Now that we’ve got the freedom and liberation of doing our podcast”
No full textIn 2022, three high-profile BBC journalists left the Corporation to start The News Agents, a daily podcast focussed on news and politics. The podcast blends serious news journalism with a light-hearted, and at times, deliberately humorous approach to the stories it covers. The setting up of The News Agents was part of a wider reorganisation of speech journalism in the UK, as seen extensively in how the BBC’s preeminent position has been challenged by a range of commercial providers. While Emily Maitlis, Jon Sopel and Lewis Goodall each had different reasons for leaving the BBC, departing from a public service media organisation where they were bound by objectivity guidelines has, in the words of Sopel, given them a newfound “freedom and liberation.” This article explores that transition, arguing that while the presenters of the podcast at times substantially diverge from public service media news values, they have simultaneously retained a degree of adherence to the BBC’s strictures to which they were formerly bound. The article employs an empirical approach that draws on podcast ethnography, to discuss the parasocial relationships the presenters have built with their audience, which particularly focuses on their use of humour
Pharmacological treatment strategies to manage precipitated withdrawal following the administration of buprenorphine in opioid use disorder:A systematic review
Get PDFBackground and aimsThere has been limited evidence synthesis examining the treatment of buprenorphine precipitated opioid withdrawal (BPOW). We aimed to conduct the first systematic review to assess the clinical utility of any pharmacological intervention in the management of BPOW.MethodsSystematic review searching Medline, Embase, PsychINFO and CENTRAL from the date of database inception to 26 August 2025 for studies of any design reporting any pharmacological intervention in the management of BPOW compared with any or no other interventions, using adult participants aged 18 or over receiving buprenorphine and experiencing BPOW. We planned to combine outcomes using random-effects meta-analysis; where this was not possible results were reported narratively. We considered two outcomes and extracted (1) any reported measure or description of the change in opioid withdrawal symptoms (OWS) and (2) the number of individuals retained in buprenorphine treatment. Outcome quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.ResultsForty-three studies met inclusion criteria reporting on 137 participants. These comprised one pilot randomised controlled trial and 42 uncontrolled observational case series or case reports. Meta-analysis was not possible, and all evidence was of low or very low quality. The currently available randomised evidence suggests that use of intravenous magnesium sulphate, in addition to symptomatic treatment with clonidine, paracetamol and diazepam, may statistically significantly reduce OWS when compared with symptomatic treatment alone. The currently available observational evidence suggests that treatment strategies which include additional doses of transmucosal buprenorphine may demonstrate higher rates of symptom control and treatment retention than strategies which do not include additional doses of transmucosal buprenorphine.ConclusionsThere is a paucity of research into pharmacological management of buprenorphine precipitated opioid withdrawal. The limited very low to low quality evidence suggests treatment regimens that include magnesium sulphate and additional doses of transmucosal buprenorphine are potentially the most salient current options and avenues for future research in the management of buprenorphine precipitated opioid withdrawal
Home-based transcranial direct current stimulation (tDCS) for bipolar depression:effects on quality of life and functioning-an open-label study
No full textPurpose: Individuals with bipolar disorder often experience reduced quality of life (QoL). Transcranial direct current stimulation (tDCS) is a promising non-invasive treatment for bipolar depression that is portable, safe, and suitable for use at home. We developed a home-based tDCS protocol with real-time remote supervision and examined its effect on QoL in bipolar depression. Methods: In an open‐label design, 44 participants (31 women) with bipolar depression of at least a moderate severity received 21 sessions of home‐based tDCS (2 mA, 30 min, F3 anode/F4 cathode) over 6 weeks, with a follow-up visit conducted 5 months from baseline. QoL was assessed using the quality of life enjoyment and satisfaction questionnaire (Q-LES-Q) at baseline, week 2, end of treatment, and follow-up session. Baseline and post treatment scores were compared with healthy control participants (28 adults; 17 women). Results: At baseline and at the end of treatment, bipolar participants showed a significantly lower Q-LES-Q score than healthy controls (p < 0.001). Within the bipolar group, there was a significant improvement in total Q-LES-Q scores (p < 0.001) and across multiple domains by week 6 and remained elevated at follow-up. Changes in Q-LES-Q were no longer significant after adjustment for depressive symptoms. Conclusion: A 6-week course of supervised home-based tDCS was associated with significant QoL improvements in bipolar depression, which appeared to be closely linked to reduction in depressive symptoms. Randomized, sham‐controlled trials are warranted to clarify the specific contribution of tDCS to improve QoL in bipolar depression.</p
Psycho-social factors associated with disagreement between prospective and retrospective measures of childhood maltreatment
Get PDFBackground: Prospective and retrospective measures of childhood maltreatment often identify different individuals and are differentially associated with psychopathology. This study examines psycho-social factors that may explain discrepancies between these measures. Methods: Data were drawn from the Environmental Risk Longitudinal Twin Study, a nationally representative birth cohort of 2,232 children born in 1994–1995 across England and Wales and followed to age 18 (93% retention). Childhood maltreatment was assessed through: (a) prospective assessments from caregivers, researchers, and clinicians at ages 5–12, and (b) retrospective self-reports at age 18 using the Childhood Trauma Questionnaire (for maltreatment occurring up to age 12). For the analyses, we focused on participants identified as maltreated from either measure (n = 290) and an a-priori selected array of potential explanatory variables assessed between ages 5–18. We conducted two sets of analyses: comparing individuals with only prospectively identified maltreatment to those identified by both prospective and retrospective measures to understand why some participants did not retrospectively report or recall maltreatment; and comparing individuals with only retrospective self-reports to those identified by both prospective and retrospective measures to understand why maltreatment had not been detected prospectively. Results: Participants in the prospective-only group reported greater social support over the life course and lower psychopathology at age 18 compared to those identified through both prospective and retrospective measures. Individuals in the retrospective-only group had higher socioeconomic status, higher self-reported adult involvement at age 12, and less exposure to domestic violence compared to those identified through both prospective and retrospective measures. Conclusions: Our findings suggest that perceptions of social support and better mental health may buffer retrospective recall of childhood maltreatment in those with prospective measures. Furthermore, more positive family functioning and socioeconomic factors may hamper prospective detection of childhood maltreatment in those who retrospectively report it.</p
Pharmacological treatment strategies to manage precipitated withdrawal following the administration of buprenorphine in opioid use disorder:A systematic review
Get PDFBackground and aimsThere has been limited evidence synthesis examining the treatment of buprenorphine precipitated opioid withdrawal (BPOW). We aimed to conduct the first systematic review to assess the clinical utility of any pharmacological intervention in the management of BPOW.MethodsSystematic review searching Medline, Embase, PsychINFO and CENTRAL from the date of database inception to 26 August 2025 for studies of any design reporting any pharmacological intervention in the management of BPOW compared with any or no other interventions, using adult participants aged 18 or over receiving buprenorphine and experiencing BPOW. We planned to combine outcomes using random-effects meta-analysis; where this was not possible results were reported narratively. We considered two outcomes and extracted (1) any reported measure or description of the change in opioid withdrawal symptoms (OWS) and (2) the number of individuals retained in buprenorphine treatment. Outcome quality was assessed using the Grading of Recommendations Assessment, Development and Evaluation (GRADE) framework.ResultsForty-three studies met inclusion criteria reporting on 137 participants. These comprised one pilot randomised controlled trial and 42 uncontrolled observational case series or case reports. Meta-analysis was not possible, and all evidence was of low or very low quality. The currently available randomised evidence suggests that use of intravenous magnesium sulphate, in addition to symptomatic treatment with clonidine, paracetamol and diazepam, may statistically significantly reduce OWS when compared with symptomatic treatment alone. The currently available observational evidence suggests that treatment strategies which include additional doses of transmucosal buprenorphine may demonstrate higher rates of symptom control and treatment retention than strategies which do not include additional doses of transmucosal buprenorphine.ConclusionsThere is a paucity of research into pharmacological management of buprenorphine precipitated opioid withdrawal. The limited very low to low quality evidence suggests treatment regimens that include magnesium sulphate and additional doses of transmucosal buprenorphine are potentially the most salient current options and avenues for future research in the management of buprenorphine precipitated opioid withdrawal