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Condition-and-perturb frontoparietal network disruption enhances preoperative nTMS mapping in patients with language-eloquent tumors: a proof-of-concept pilot study
No full textBackground
The use of preoperative neuronavigated transcranial magnetic stimulation (nTMS) is becoming increasingly common in patients undergoing eloquent brain tumor surgery. Yet the optimal stimulation paradigms for language mapping still lack specificity and need to be refined. In the frontoparietal network, a protocol of dual-site TMS, termed the condition-and-perturb approach (CAP), was shown to effectively sensitize the semantic network in healthy subjects.
Objective/Hypothesis
This study aims to evaluate the added value of the CAP to preoperative language mapping in non-aphasic patients with language-eloquent brain tumors involving the anterior inferior frontal (aIFG) or angular (AG) gyrus.
Methods
Patients underwent peritumoral online nTMS involving the affected node (AG or aIFG) with or without prior offline neuronavigated repetitive TMS (nrTMS, 1 Hz, 15 min) of the ipsilateral healthy node (aIFG or AG).
Results
Eight patients underwent the full protocol. Offline nrTMS decreased error threshold of online language mapping in all patients in comparison to sham nrTMS in those patients. Four peritumoral language hotspots [2–5] could be isolated in each patient. Compared to direct cortical stimulation, nTMS language mapping with CAP achieved a sensitivity of 84.2%, a specificity of 98.3%, a PPV of 84.2% and an NPV of 98.3%. This means that nearly all CAP-nTMS hotspots induced language disturbances when stimulated intraoperatively with DCS.
Conclusions
This pilot study suggests that the CAP could be a possible solution to the specificity concerns of preoperative TMS mapping, as prior frontoparietal network disruption might enhance the precision of language mapping around semantically eloquent brain tumors
Disparities in diabetes treatment and monitoring for people with and without mental disorders: a systematic review and meta-analysis
No full textBackground
People with mental disorders have an increased risk of diabetes, yet conflicting evidence exists regarding the quality of diabetes care they receive. To address this evidence gap, we conducted a systematic review and meta-analysis to assess and compare diabetes quality of care in people with diabetes with mental disorders versus people with diabetes without mental disorders.
Methods
In this systematic review and random-effects meta-analysis, we searched Scopus, Embase, MEDLINE, and PsycINFO for cohort and case-control studies published between database inception and Feb 8, 2025. We estimated summary odds ratios (ORs) for diabetes quality of care indicators in individuals with any mental disorder versus without mental disorders to investigate the association between the presence of a mental disorder and diabetes quality of care indicators, including overall diabetes monitoring and treatment. Studies were excluded if it was not possible to generate pooled quantitative data. The primary outcome was a binary composite measure of diabetes quality of care, meaning the percentage of people receiving any diabetes monitoring and treatment (ie, urine albumin-creatinine ratio test, HbA1c test, blood pressure measured, foot surveillance, serum creatinine test, serum cholesterol test, BMI recorded, smoking status recorded, retinal monitoring). Secondary outcomes were study-specific diabetes quality of care individual indicators matched to the nine NICE diabetes monitoring indicators and specific diabetes interventions and anti-diabetes medications. We analysed primary and secondary outcomes according to any mental disorder and to specific diagnostic subgroups. Study quality was evaluated using the Newcastle–Ottawa Scale (NOS).
Findings
Data from 49 studies (42 cohort and seven case-control) were included, comprising 5 503 712 individuals with diabetes, of whom 838 366 (15·2%) had a diagnosed mental disorder (defined using ICD-9 or ICD-10 criteria in 40 studies). Sex was reported in 35 of 49 studies, comprising 4 250 666 individuals, 1 956 506 (46·0%) of whom were female and 2 294 160 (54·0%) were male. The mean age was 61·4 years (SD 8·7; range 47–82 years). 38 studies reported on various mental disorders, 21 on mood disorders spectrum, 21 on major depressive disorder, 20 on schizophrenia, 11 on bipolar disorder, 11 on substance use disorder spectrum, including alcohol use disorder, six on dementia, five on anxiety disorder spectrum, and one on personality disorder spectrum. Most studies were high quality and spanned Asia, North America, Europe, and Australasia. Significant negative associations were observed between having any mental disorder and the likelihood of receiving any recommended diabetes monitoring (29 studies, OR=0·81 [95% CI 0·70–0·94], p=0·0049). Negative associations were also observed for HbA1c measurement (24 studies, 0·81 [0·68–0·97], p=0·024), retinal screening (21 studies, 0·77 [0·63–0·95], p=0·013), lipid and cholesterol measurement (20 studies, 0·83 [0·69–0·99], p=0·043), foot examination (11 studies, 0·85 [0·76–0·95], p=0·0044), and renal investigation (16 studies, 0·78 [0·63–0·96], p=0·022). A significant positive association was found between any mental disorder and recorded smoking status (two studies, 1·09 [1·02–1·17]; p=0·0076). Any mental disorder was significantly associated with higher odds of receiving insulin (ten studies, 1·52 [95% CI 1·16–1·99]; p=0·0022), but negatively associated with treatment with a GLP-1 receptor agonist (two studies, 0·26 [0·13–0·49]; p<0·0001). There was no evidence of publication bias.
Interpretation
Mental disorders are negatively associated with receiving adequate diabetes monitoring and GLP-1 agonist therapy. Addressing these disparities has the potential to address the increased mortality associated with mental disorders
Hidden champions and knowledge spillovers: innovation-enhancing agglomeration effects and niche technology specificity
Get PDFTo achieve market and technology leadership, innovation is essential for niche market leaders. While research suggests that regions benefit economically from a high concentration of niche market leaders, it is still unclear which role locating close to one another plays for their innovation performance. Therefore, we contribute to existing literature that studies external factors of firm-level innovation. We analyze 1372 German niche market leaders and study whether (1) being located in a cluster improves their innovation performance and (2) if the impact of locating in a cluster varies depending on the diversity of industries within the cluster. We measured the spatial agglomeration using the location quotient. Our findings show that being located in a cluster increases the patenting rate by 1.49 times. This effect is more pronounced in clusters with more diverse industries, indicating a lower level of technology specificity. This suggests that technology specificity has an impact on a company’s ability to take advantage of positive knowledge from other companies in the same cluster. Finally, we conducted several tests to ensure the robustness of our analysis. The Modifiable Areal Unit Problem (MAUP) refers to the discretionary choice of the spatial unit, and we tested different spatial unit levels to account for this. Additionally, we used entropy balancing to confirm the positive effect of cluster location on innovation, comparing with a control set of mass-market firms. Our study concludes with implications for both corporate management and public policy
The ILIA study: protocol for a randomized-controlled multicenter clinical trial on smartphone- and web-based relapse monitoring for patients with schizophrenia or schizoaffective disorder
No full textBackground: Despite the proven efficacy of antipsychotics in relapse prevention in schizophrenia and schizoaffective disorder, every third patient experiences a relapse within less than one year. Relapses can worsen psychosocial and treatment related outcomes and lead to substantial economic costs, primarily due to frequent and prolonged hospitalizations. The aim of this project is to evaluate a smartphone- and web-based digital solution for detecting early warning signs of schizophrenia and schizoaffective disorder to reduce relapses and subsequent hospitalizations.
Methods: This randomized controlled trial compares the add-on use of a smartphone-based app for monitoring relapse warning signs in patients with schizophrenia and schizoaffective disorders (ICD-10 F20/F25) used within the routine psychiatric outpatient treatment against treatment as usual (TAU) without any further study-related intervention. Patients in the intervention group use the app for one year, fill in the weekly ten-item Early Warning Signs Questionnaire (EWSQ-10P) and obtain in-app feedback. Clinicians can access the symptom trajectory via a browser-accessible dashboard. If a threshold is exceeded in the inbuilt automatic algorithm, an alert is sent to both, the clinician and patient, enabling timely contact and, as part of a shared decision-making process, an optional adjustment of treatment decision. A total of 110 outpatients are recruited across eight study sites.
Discussion: Continuous monitoring of early warning signs is expected to lead to behavioral changes and to decrease the necessity and duration of psychiatric hospital stays, thereby lowering healthcare costs. Additionally, the intervention could reduce symptom severity, alleviate medication adherence, shared decision-making, patient activation or quality of life. Qualitative data is collected to better understand patient needs and preferences regarding app usage and relapses. Insights gained from this study can be integrated into routine psychiatric care, improving the long-term treatment of patients with schizophrenia or schizoaffective disorder
Perioperative nutrition practices in gastrointestinal cancer surgery: a nationwide survey among German surgical departments
No full textPerioperative nutrition is a cornerstone of enhanced recovery in gastrointestinal cancer surgery, with international guidelines recommending early oral intake and standardized screening. This study aimed to assess current perioperative nutrition practices in German surgical departments and evaluate their alignment with guideline-based recommendations.
Methods: A nationwide cross-sectional survey was conducted between September 18, 2024, and January 2, 2025, involving surgical departments that perform major gastrointestinal cancer resections. The 93-item anonymous questionnaire addressed pre- and postoperative nutrition strategies related to esophagectomy, gastrectomy, pancreatoduodenectomy and colorectal resections. Descriptive statistics were used to analyse the responses.
Results: A total of 263 hospitals participated in the survey. More than one-third of hospitals (35.1%) reported no routine preoperative malnutrition screening and only 6.7% performed a structured nutritional assessment. There was no consistent agreement on postoperative feeding strategies including the timing of oral intake especially in upper gastrointestinal surgery. Nasogastric tubes were routinely placed postoperatively in 66 .1% of gastrectomies, 63.5% of esophagectomies, and 64.6% of pancreatoduodenectomies, but timing of postoperative removal varied widely. Hospitals with higher levels of care (e.g. university or maximum care hospitals) were significantly more likely to perform routine malnutrition screening (p = 0.002) and to allow early drinking after colorectal surgery (p < 0.001). The presence of structured nutrition support teams was associated with higher rates of guideline-compliant preoperative screening (76.3% vs. 47.4%; p < 0.001).
Conclusion: Perioperative nutrition practices in German gastrointestinal cancer surgery vary considerably and often deviate from established guidelines.These findings underline the need for greater standardization and broader adoption of evidence-based perioperative nutrition strategies to ensure optimal patient outcomes
Mössbauer spectroscopy on antimony borosulfates reveals weak coordination behavior
No full textWith MIIIMI[B(SO4)2]4 (MIII = Bi3+, Sb3+, Lu3+; MI = H3O+, NO2+, Li+, Na+, K+, Rb+, Cs+), we recently described the first modular system within borosulfate chemistry comprising a three-dimensional anion. Herein, we shed light on the respective series of antimony compounds SbX[B(SO4)2]4 (X = Li+, Na+, K+, Rb+, Cs+, Ag+, Tl+, NO+, NH4+). While maintaining the same anionic topology, the compounds crystallize in the space groups Imathematical equation (no. 82), Pmathematical equation (no. 81), and C2 (no. 5) and are strongly influenced by the lone pair of antimony as well as the size of the monovalent cations. In the course of this investigation SbX[B4O2(SO4)6] (X = Li+, Na+) were discovered. This borosulfate with a one-dimensional anion comprising B─O─B bridges crystallizes in the space group Pnma (no. 62) and features a new structure type. 121Sb Mössbauer spectra revealed negative isomer shifts of almost −22 mm·s−1 not observed before and hinting towards a very weak coordination behavior of the borosulfate anion. The spectra are confirmed by DFT calculations. Furthermore, single crystal X-ray diffraction, infrared spectroscopy, thermal analysis, and temperature programmed X-ray diffraction experiments were carried out
Motivated and feeling good? Reciprocal relations between motivational regulation and student well-being over one semester
No full textWhile prior research shows that motivational regulation (MR) predicts study motivation and academic success, its relations with students' subjective well-being (SWB) are not yet well understood. It can be theoretically assumed that MR and SWB are reciprocally linked over time, but longitudinal evidence is lacking. To advance our understanding of these associations, we conducted a three-wave longitudinal study with 527 university students across one semester. We included frequency of strategy use, situation-specific fit, and application quality as MR components. Results from cross-lagged panel analyses indicate that high SWB serves as a resource for applying MR strategies frequently and with a high quality, while situation-specific fit and application quality can boost SWB over time. These findings provide insight into the interplay between MR and SWB over time, illuminate the role of SWB as a MR precondition, and can help to develop support measures fostering study success and health in higher education
A multilayer model of automatization: core processes driving the emergence of automatic action control
No full textThe final stage of a learning process is often described as automatic, meaning that skills are executed in a seemingly effortless manner, fast, and without attentional control. Yet, over the past decades, various theories offered different concepts of what "automatic" means and how automatic and non-automatic processes relate to each other. Likewise, there is ongoing debate about the mechanisms underlying the transition from non-automatic to automatic processes. In this article, we propose a model that specifies how automatization emerges through practice. The central idea of our Multilayer Model of Automatization (MMA) is that cognitive control operates across hierarchically organized processing levels that each display characteristics of both controlled and automatic processing. The superordinate level controls the behavior of the subordinate levels by specifying tasks, determining control policies, and monitoring output, thereby incurring additional costs in terms of time and effort. The control units in the MMA are adaptive: they can learn to recognize regularities, anticipate tasks, and generate goal-directed outputs. During this learning process, lower level units gradually become more independent from higher-level control signals, thereby freeing higher-level processing capacities. We specify the necessary and sufficient prerequisites and mechanisms for automatization to be successfully produced by our MMA. Furthermore, we conceptualize automaticity not as a binary, all-or-none phenomenon, but as a gradual or partial property. We can observe the degree of automaticity by the amount of control signals exchanged across control levels. Finally, we explain and discuss how the properties of the MMA correspond to human automatization processes, allowing for specific predictions of automated behavior. The article concludes with an outlook on phenomena and open questions that can be addressed through the MMA framework
Gesundheit, 'Krankheit' und medizinisches Wissen in den Oneirokritika des Artemidor von Daldis
No full textIMAGINE – Eindrücke von der EAHIL-Tagung 2025 in Łódź, Polen
No full textDie Jahrestagung der European Association for Health Information and Libraries (EAHIL) fand dieses Jahr vom 10. bis 13. Juni 2025 unter dem Motto „IMAGINE“ in Łódź, Polen, statt und bot Fachkolleginnen und -kollegen aus ganz Europa ein Forum für Austausch, Weiterbildung und Vernetzung. Der Bericht gibt einen Überblick über zentrale Themen und Eindrücke der Tagung, die sich durch eine große Vielfalt praxisorientierter und wissenschaftlicher Beiträge auszeichnete. Im Mittelpunkt standen aktuelle Herausforderungen des medizinischen Bibliothekswesens, darunter Fragen der Informationskompetenz im Zeitalter Künstlicher Intelligenz, Strategien zur Bewältigung beruflicher Belastungen, Ansätze zur Förderung von Community Engagement sowie der verantwortungsvolle Umgang mit wissenschaftlicher Integrität und Predatory Publishing. Daneben kamen auch bibliotheksdidaktische Formate und Themen, etwa Gamification im Rahmen der Teaching Library oder kreative Kommunikationsstrategien gegenüber Stakeholdern und relevanten Zielgruppen von Medizinbibliotheken nicht zu kurz. Insgesamt verdeutlichte die Tagung, dass Bibliotheken zunehmend als dynamische Lernräume agieren, die Wissen, Reflexion und Gemeinschaft fördern