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Sex Disparities in Infective Endocarditis Presentation, Management and Outcomes: A Systematic Review and Meta-Analysis
Get PDFBackground: Sex-based disparities in the presentation, management, and outcomes of infective endocarditis (IE) remain insufficiently characterized despite their growing recognition. This study systematically evaluates current evidence on sex differences in the presentation, treatment, and outcomes of IE. Methods: A systematic review and meta-analysis were conducted according to PRISMA and Cochrane guidelines. EMBASE, MEDLINE, PubMed, the Cochrane Library, and Google Scholar were searched up to October 2024. Twenty-four studies including 139,952 patients (79,698 men and 60,254 women) were analyzed. Primary outcomes were mortality (in-hospital, 30-day, and 1-year), stroke, and treatment modality (medical vs. surgical). Secondary outcomes included complications, procedural characteristics, and hospital course. Results: Men were younger at diagnosis and had higher rates of substance abuse and coronary artery disease, while women more often had hypertension, diabetes, chronic lung disease, and prior valvular pathology. Men more frequently had aortic and prosthetic valve IE, whereas women had mitral and tricuspid involvement. Men were about 65% more likely to undergo surgery for infective endocarditis than women, while women were predominantly managed medically. Men had lower in-hospital (OR 0.81, 95% CI 0.72-0.92) and 1-year mortality (OR 0.76, 95% CI 0.61-0.94), though 30-day mortality did not differ significantly. Women experienced shorter hospital stays but longer ICU admissions and more heart failure, whereas men had more recurrent IE. Conclusions: Men underwent surgery more often and had better short- and long-term survival. Women presented later, with greater comorbidity and higher complication rates. Enhanced recognition of sex-specific risk and equitable surgical referral may improve IE outcomes
Universal Digital Identity Stakeholder Alignment: Toward Context-Layered RAG Architectures for Ecosystem-Aware AI
Get PDFA universal approach to managing a person’s digital identity may be the single most important advancement to the Internet since its inception, promising the seamless flow of information, averting cybercrime, eliminating login credentials, and restoring privacy and trust through greater control of one’s identity online. However, this advancement brings significant risks, especially regarding personal privacy. It demands the meticulous development of digital identity infrastructure that balances robust data security measures with ethical handling of sensitive information, thereby safeguarding against misuse and unauthorised access. Currently, a consolidated vision for digital identity implementation remains unresolved, and aligning the different stakeholders’ motives and expectations is a challenging task. This article reviews and analyses the perspectives and expectations of four key stakeholder groups—government, business, academia, and consumers—regarding a digital identity ecosystem, aiming to increase trust in an eventual design framework. Using an online survey stratified across government, business, academia, and consumers, we identify areas of alignment and divergence regarding privacy, trust, usability, and governance expectations. We then encode these stakeholder expectations into a layered conceptual structure and illustrate its use as metadata for context-layered retrieval-augmented generation (RAG) in digital identity scenarios
Preferences for redistribution inthree spheres of inequality
Get PDFMy thesis revolves around the question of why people reject full equality and tolerate that some individuals are economically better off than others. The common thread is the attention paid to the role of fairness beliefs. I focus on three specific areas where economic inequality perpetuates itself and where different policies could be implemented. First, I study how individuals justify wage inequality across occupations. I conducted an original survey in the UK and demonstrate that, when considering market inequality and the concept of merit, individuals place value on both the inputs that workers provide, such as effort or skills, and the outputs they achieve through their jobs. Additionally, employing conjoint analysis, I show that individuals are more willing to economically reward the merit-related aspects of a job than those unrelated to merit. Mainly, they are willing to reward the responsibility attached to the job and the level of mental skills it requires. Second, my research explores citizens' support for increasing taxes on the rich. I examine whether the philanthropy of the wealthy influences individuals' willingness to tax them. I designed and conducted two survey experiments in the U.S. and observe that charitable donations by the super-rich make them seem more benevolent and greater contributors to the well-being of the poor. Moreover, I find that citizens are less willing to tax the super-rich when presented with positive information about their philanthropy. Finally, I investigate why natives are often reluctant to grant social rights to immigrants. I focus particularly on how natives value immigrants' fiscal contributions. Through conjoint analysis in three countries, I find that natives are less willing to support social rights for immigrants who are described as negative fiscal contributors, even when they are informed about immigrants' positive intentions and the structural barriers they face
Bills of lading and the logic of possession
No full textThe holder of a bill of lading is, according to orthodoxy, protected from third-party interference with the goods because they are in possession or in constructive possession of the goods. This article challenges that view. It argues that the bill holder is not in possession of the goods, such possession being inconsistent with the carrier’s. It also argues that the bill holder is not in constructive possession of the goods. The custom of merchants, the carrier holding the goods to the bill-holder’s order, and any personal right of the bill holder do not justify protecting the bill holder against third parties
Building High Involvement Work Systems in the Digital Era: Employee Experience‐Oriented Digital HRM and Employee Involvement
Get PDFDespite the increasing application of digital technology in management practices, its implications for employee involvement and high involvement work systems (HIWSs) remain largely unexplored. Based on an in‐depth qualitative case study of Tencent—one of China's largest information technology companies—this article explores whether and in what ways employee experience (EX)‐oriented digital HRM contributes to the development of HIWSs. Drawing on socio‐technical systems theory, we examine the goals, tasks, structures, actors, and technical elements of the digital HRM system in the case company, as well as the interactions among these elements. Our findings suggest that the EX‐oriented digital HRM system enhances two key dimensions of HIWSs: technological empowerment and organizational involvement. First, EX‐oriented digital HRM provides employees with digital tools that enable them to exercise some autonomy in various facets of their work life. This includes self‐management, team collaboration, and personalized learning and development opportunities. Second, EX‐oriented digital HRM arguably promotes employee involvement in both product development and some aspects of organizational management by leveraging user experience design. This study contributes to the theory of socio‐technical systems and the literature on HIWSs in the digital era
Harnessing Controlled Dealloying–Support Coupling for Ultrastable PtNi Catalysts in PEMFC Applications
Get PDFPlatinum–transition metal (PtM) alloys are among the most promising oxygen reduction reaction (ORR) catalysts, yet their practical deployment in proton‐exchange membrane fuel cells (PEMFCs) is hindered by transition‐metal dissolution, particle coarsening, and insufficient durability. Moreover, conventional alloying or intermetallic ordering strategies often aggravate these issues by inducing severe nanoparticle aggregation and instability. Here we report a controllable alloying–dealloying strategy to construct PtNi nanoparticles confined in an N‐doped carbon framework (Pt1Ni1‐x@Nix_NC). Ammonia‐assisted dealloying produces a Pt‐rich shell with an alloyed core, while the N‐doped carbon anchors the released Ni atoms form Ni–N/C moieties, thereby suppressing agglomeration and strengthening metal–support interactions. This coordination–support coupling optimizes Pt 5d orbital occupation, weakens oxygen adsorption, and accelerates ORR kinetics. Consequently, Pt1Ni1‐x@Nix_NC exhibits a half‐wave potential of 0.932 V and an ultrahigh mass activity of 2.028 A mgPt−1, which is 8.75‐fold higher than commercial Pt/C and among the best values reported to date for PtNi‐based catalysts. Remarkably, it shows only a 6 mV half‐wave potential loss after 30,000 cycles, demonstrating exceptional durability. In PEMFCs, the fuel cell delivers 975 mW cm−2 peak power density and retains 91.9% of initial performance, underscoring a generalizable approach for designing durable, high‐performance low‐PGM catalysts for next generation PEMFCs
The galaxy–environment connection revealed by constrained simulations
Get PDFThe evolution of galaxies is known to be connected to their position within the large-scale structure and their local environmental density. We investigate the relative importance of these using the underlying dark matter density field extracted from the Constrained Simulations in BORG (CSiBORG) suite of constrained cosmological simulations. We define cosmic web environment through both dark matter densities averaged on a scale up to 16 Mpc , and through cosmic web location identified by applying DisPerSE to the CSiBORG haloes. We correlate these environmental measures with the properties of observed galaxies in large surveys using optical data (from the NASA-Sloan Atlas) and 21-cm radio data (from ALFALFA). We find statistically significant correlations between environment and colour, neutral hydrogen gas () mass fraction, star formation rate, and Sérsic index. Together, these correlations suggest that bluer, star-forming, rich, and disc-type galaxies tend to reside in lower density areas, further from filaments, while redder, more elliptical galaxies with lower star formation rates tend to be found in higher density areas, closer to filaments. We find analogous trends with the quenching of galaxies, but notably find that the quenching of low-mass galaxies has a greater dependence on environment than the quenching of high-mass galaxies. We find that the relationship between galaxy properties and the environmental density is stronger than that with distance to filament, suggesting that environmental density has a greater impact on the properties of galaxies than their location within the larger-scale cosmic web
Development and validation of AI-Enhanced auscultation for valvular heart disease screening through a multi-centre study
Get PDFValvular heart disease (VHD) is a growing public health concern, yet over half of cases remain undiagnosed due to late symptom onset, limited public awareness, and low sensitivity of traditional stethoscope-based screening. Current AI-enabled tools rely on murmur detection as a proxy for VHD but lack sensitivity for common subtypes like mitral regurgitation and are limited by small datasets. This study presents a novel neural network that directly predicts clinically significant VHD from stethoscope recordings, trained using echocardiographic targets rather than heart murmur labels. A diverse dataset of 1767 patients across UK primary care and hospital settings was developed, combining stethoscope recordings with echocardiographic labels. The trained recurrent neural network achieved an AUROC of 0.83, outperforming general practitioners and demonstrating exceptional sensitivity for severe aortic stenosis (98%) and severe mitral regurgitation (94%). This algorithm shows promise as a scalable, low-cost screening tool, enabling earlier diagnosis and timely referral for intervention. This research was registered with ClinicalTrials.gov (CAIS: NCT04445012 registered on 2020-06-21, DUO-EF: NCT04601415 registered on 2020-10-19)
Beyond overconfidence: Embedding curiosity and humility for ethical medical AI
Get PDFContemporary medical AI systems exhibit a critical vulnerability: they deliver confident predictions without mechanisms to express uncertainty or acknowledge limitations, leading to dangerous overreliance in clinical settings. This paper introduces the BODHI (Bridging, Open, Discerning, Humble, Inquiring) framework, a dual-reflective architecture grounded in two essential epistemic virtues: curiosity and humility, as foundational design principles for healthcare AI. Curiosity drives systems to actively explore diagnostic uncertainty, seek additional information when faced with ambiguous presentations, and recognize when training distributions fail to match clinical reality. Humility provides complementary restraint, enabling uncertainty quantification, boundary recognition, and appropriate deference to human expertise. We demonstrate how these virtues function synergistically in a dynamic feedback loop, preventing both reckless exploration and excessive caution while supporting collaborative clinical decision-making. Drawing from psychological theories of curiosity and cross-species evidence of epistemic humility, we argue that these capacities represent fundamental biological design principles essential for systems operating in high-stakes, uncertain environments. The BODHI framework addresses systemic failures in medical AI deployment, from biased training data to institutional workflow pressures, by embedding uncertainty awareness and collaborative restraint into foundational system architecture. Key implementation features include calibrated confidence measures, out-of-distribution detection, curiosity-driven escalation protocols, and transparency mechanisms that adapt to clinical context. Rather than pursuing algorithmic perfection through pure optimization, we advocate for human-AI partnerships that enhance clinical reasoning through mutual accountability and calibrated trust. This approach represents a paradigm shift from overconfident automation toward collaborative systems that embody the wisdom to pause, reflect, and defer when appropriate
Refining Detection of Subclinical Epileptiform Activity in Alzheimer's Disease: A Case–Control Study and Call for a Consensus
Get PDFObjective: Sleep‐predominant network hyperexcitability is increasingly recognized as a potential disease‐accelerating comorbidity in Alzheimer's disease (AD). However, its prevalence and risk‐factors remain debated, largely due to cohort‐specific and methodological differences across studies. In this prospective case‐control study, we investigated potential ways of improving detection, from translational approaches focusing on rapid eye movement (REM)‐sleep to refined electroencephalogram (EEG) setups and added clinical questionnaires. Methods: We recruited 30 patients with early‐stage AD without a history of epilepsy and 30 age‐matched controls. Participants underwent overnight polysomnography with video‐EEG. Interictal epileptic discharges (IEDs) were identified through a structured 3‐step review by multiple independent experts using recommended criteria. Neuroanatomic patterns and sleep‐related abnormalities were investigated as potential risk factors. Clinical symptoms in favor of epileptic seizures were evaluated through a tailored questionnaire at follow‐up. Results: IEDs were detected in 3 patients (10%) and 1 control (3.33%), a difference not reaching statistical significance (p = 0.612). Most events occurred during non‐REM (NREM) sleep. Eight patients (26.67%) reported symptoms compatible with epileptic seizures—one of whom also presented with IEDs. Patients with IEDs or reported symptoms suggestive of potential seizures exhibited more severe sleep‐disordered breathing and reduced precuneus volume compared with those without. Interpretation: Despite efforts to optimize detection accuracy, our findings reveal a lower‐than‐expected percentage of patients with AD with IEDs, yet support previous findings suggesting that sleep‐disordered breathing and specific atrophy patterns could flag at‐risk patients, guiding screening in clinical settings. Our findings also favor validation efforts of questionnaires to support the diagnostic process. Finally, we highlight methodological issues in IED detection and call for the re‐evaluation and standardization of diagnostic methods and criteria in this population to improve patient care. ANN NEUROL 202