Understanding the mechanisms underlying the emergence and spread of high pathogenicity avian influenza virus (HPAIV) is critical for tracking its global dissemination, particularly via migratory seabirds, given their role in transmission over long distances. Scavenging seabirds, such as skuas, may act as both reservoirs and vectors, and have been linked to multiple outbreaks since 2021. Here, we report the detection of HPAIV H5N1 clade 2.3.4.4b in three Tristan skua (Stercorarius antarcticus hamiltoni) carcasses on Gough Island in the central South Atlantic Ocean. To investigate potential incursion routes, we combined genomic analyses with year-round tracking data from global location sensors. Although migratory movement patterns suggested southern Africa as the most obvious pathway, the strain detected on Gough Island was more closely related to that identified in South Georgia, indicating that infection may have occurred during the pre-laying exodus, when skuas disperse into frontal waters south of the island. No further cases have been confirmed for Gough, but more systematic monitoring is needed to understand the dynamics of virus infection. The detection of HPAIV H5N1 in skuas on Gough Island highlights the importance of continued vigilance, proactive and geographically inclusive surveillance strategies, and biosecurity measures globally, alongside efforts to reduce other pressures on globally important seabird populations to help strengthen their resilience.
Island biota is currently threatened by global anthropogenic pressures. The limited ability of island species to track suitable conditions and their inherent sensitivity to anthropogenic changes make insular biota highly vulnerable to global threats. Although vulnerability assessments of species to single threats individually have been conducted, the vulnerability of island faunas to multiple global change drivers has not. We evaluated the relative vulnerability of 266 insular bird and mammal species from 45 islands in six well-studied archipelagos to multiple threats. We first quantified the current exposure of islands to climate change, land-use change, and biological invasions. We then calculated insular assemblage sensitivity based on species' ecological characteristics, such as diet and habitat specialization, generation length, and geographical rarity. To assess the adaptive capacity of insular species in response to these threats, we examined biotic and abiotic features, such as species' dispersal ability, terrain heterogeneity, and proportion of protected area. Exposure and adaptive capacity markers varied greatly among the six archipelagos, but the mean sensitivity of assemblages was similar across islands. Hawai'i, the Azores, and the Mascarenes had high vulnerability scores. Climate change and biological invasions were dominant threats in Hawai'i, and land-use change was the dominant threat in the Mascarenes, Azores, and Canaries. Assemblages from the Galapagos and Tristan da Cunha had lower vulnerability to current threats. The differences in vulnerability among island assemblages, mostly arising from differences in exposure and adaptive capacity, mean these islands' conservation needs differ. Our results delineate the mechanisms behind the vulnerability of insular biota under global change, a necessary step to effectively preserve island biodiversity and its associated human benefits. Perfiles de vulnerabilidad contrastantes para conjuntos insulares de aves y mamíferos que se enfrentan al cambio global Resumen La biota insular se encuentra actualmente amenazada por las presiones antropogénicas globales. La capacidad limitada de las especies insulares para adaptarse a condiciones adecuadas y su sensibilidad inherente a los cambios antropogénicos hacen que la biota insular sea muy vulnerable a las amenazas globales. Si bien se han realizado evaluaciones de la vulnerabilidad de las especies a amenazas individuales, no se ha evaluado la vulnerabilidad de la fauna insular a múltiples factores de cambio global. Evaluamos la vulnerabilidad relativa de 266 especies de aves y mamíferos insulares de 45 islas en 6 archipiélagos bien estudiados frente a múltiples amenazas. En primer lugar, cuantificamos la exposición actual de las islas al cambio climático, al cambio en el uso del suelo y a las invasiones biológicas. A continuación, calculamos la sensibilidad de los conjuntos insulares basándonos en las características ecológicas de las especies, como la especialización en la dieta y el hábitat, la duración de la generación y la rareza geográfica. Para evaluar la capacidad de adaptación de las especies insulares en respuesta a estas amenazas, examinamos características bióticas y abióticas, como la capacidad de dispersión de las especies, la heterogeneidad del terreno y la proporción de áreas protegidas. Los marcadores de exposición y capacidad de adaptación variaron mucho entre los seis archipiélagos, pero la sensibilidad media de los conjuntos fue similar en todas las islas. Hawái, las Azores y las Mascareñas obtuvieron puntuaciones altas en vulnerabilidad. El cambio climático y las invasiones biológicas fueron las amenazas predominantes en Hawái, mientras que el cambio en el uso del suelo fue la amenaza predominante en las Mascareñas, las Azores y las Canarias. Las comunidades de las Galápagos y Tristán da Cunha mostraron una menor vulnerabilidad a las amenazas actuales. Las diferencias en la vulnerabilidad entre las comunidades insulares, derivadas principalmente de las diferencias en la exposición y la capacidad de adaptación, implican que las necesidades de conservación de estas islas son diferentes. Nuestros resultados describen los mecanismos que subyacen a la vulnerabilidad de la biota insular ante el cambio global, un paso necesario para preservar eficazmente la biodiversidad insular y los beneficios humanos asociados a ella. 【摘要】 岛屿生物群落正面临着全球人为压力因素的威胁。岛屿物种追踪适宜环境的能力有限, 且对人为变化具有内在敏感性, 导致岛屿生物群落极易受到全球性威胁的影响。虽然目前已有关于物种面对单一威胁的脆弱性评估, 但岛屿动物群面对多重全球变化驱动因素的脆弱性尚不清楚。本研究评估了6个得到充分研究的群岛中45个岛屿266种岛屿鸟类和哺乳动物对多重威胁的相对脆弱性。我们首先量化了岛屿当前面临的气候变化、土地利用变化和生物入侵暴露程度, 并基于物种生态特征(如食性与栖息地特化、世代时长及地理稀有性)计算了岛屿群落敏感性。为评估岛屿物种应对这些威胁的适应能力, 我们进一步纳入了生物与非生物特征, 包括物种扩散能力、地形异质性及保护地比例的分析。结果显示, 六个群岛间暴露指标与适应能力指标差异显著, 但其群落平均敏感性水平相近。夏威夷、亚速尔群岛和马斯克林群岛的脆弱性评分较高。气候变化与生物入侵是夏威夷的主要威胁, 而马斯克林群岛、亚速尔群岛和加纳利群岛的主要威胁则是土地利用变化。加拉帕戈斯群岛和特里斯坦‐达库尼亚群岛的群落对当前威胁的脆弱性较低。岛屿物种群落脆弱性的差异主要源于暴露程度与适应能力的差异, 这意味着不同岛屿的保护需求也不尽相同。我们的研究结果揭示了全球变化背景下岛屿生物群落脆弱性的内在机制, 这是有效保护岛屿生物多样性及有关人类惠益的关键步骤。【翻译:胡怡思;审校:聂永刚】.
Although local adaptation influences species distributions, its role in driving evolutionary resilience under climate change remains unclear. Current predictive models focus on genetic adaptation to present climates, providing limited insight into future adaptive capacity. We hypothesise that historical responses to climatic shifts can reveal candidate loci for local adaptation in the future. Combining ecological niche modelling and genomic analyses, we investigate spatiotemporal patterns and mechanisms of local adaptation of the Western Palearctic barn owl (Tyto alba). Ecological modelling reveals that barn owls now occupy a broader climatic niche than during the Last Glacial Maximum. Genomic analyses indicate ongoing adaptation, with regions under selection linked to environmental factors across all populations. We find that local adaptation drives evolutionary changes across populations, enabling colonisation of new habitats and shaping responses to climate change in resident populations. We show that standing genetic diversity plays a crucial role in adaptation to past, present, and future environmental shifts.
This ex vivo study aimed to determine the optimal energy level for virtual monoenergetic imaging (VMI) using photon-counting detector computed tomography (PCD-CT) and to evaluate the effectiveness of iterative metal artifact reduction (iMAR) in assessing simulated endodontic challenges and complications. Sixteen extracted third molars were simulated with one of eight distinct endodontic diagnostic challenges and imaged using PCD-CT at radiation doses equivalent to standard-dose cone-beam CT. VMIs were reconstructed from 70-190 keV at 10 keV increments, both with and without iMAR. Diagnostic accuracy, depiction quality of endodontic challenges, artifact severity, and visualization of key endodontic anatomical structures were independently assessed by 2 observers using a 5-point visual analogue scale (1 = least favourable, 5 = most favourable). Descriptive statistics were calculated, and inter-reader agreement was analysed using Krippendorff's alpha coefficient. VMIs achieved excellent diagnostic accuracy (97%) and high-quality visualization of endodontic challenges (median: 5, IQRs: 4-5 or 4.25-5; α = 0.63-1.00) across the entire reconstructed energy spectrum (70-190 keV), with minimal artifacts, particularly at ≥ 110 keV (α = 1.0). Task-specific analysis demonstrated optimal visualization of caries at 70-80 keV and fractured files at 70-100 keV. For other pathologies, VMI at ≥100 keV effectively reduced artifacts without compromising anatomical detail. IMAR did not improve image quality and consistently reduced diagnostic performance. VMI from PCD-CT provides high-quality imaging with minimal artifacts, well-suited for indication-specific endodontic diagnostics. PCD-CT supports novel, indication-specific workflows in endodontic imaging, potentially enhancing diagnostic precision and long-term treatment follow-up.
Methicillin-resistant Staphylococcus aureus (MRSA) remains a major public health concern due to its antibiotic resistance and virulence potential. This study aimed to characterizes tst-positive MRSA strains identified among 150 clinical isolates collected between 2020 and 2023 at Mustapha Bacha Hospital, Algiers, Algeria. Antimicrobial susceptibility testing was performed according to CLSI guidelines. The methicillin resistance genes (mecA and mecC) and virulence gene tst were detected by PCR. In addition, whole genome sequencing (WGS) was conducted on all tst-positive isolates to determine their multilocus sequence types (MLST), antimicrobial resistance and virulence gene profiles, and single nucleotide polymorphisms (SNPs), in order to determine clonal relatedness. Among the 150 isolates tested, 143 carried the mecA gene, while the remaining seven were negative. The mecC gene was not detected. Eight MRSA (5.3%) carried the tst gene encoding toxic shock syndrome toxin-1 (TSST-1). The predominant clone was ST22-MRSA-IV, detected in seven isolates, while one strain belonged to ST39-MRSA-II. This study reports the detection of tst-positive ST22-MRSA (Gaza epidemic clone) and a multidrug-resistant ST39-MRSA isolates at Mustapha Bacha Hospital, underscoring the need for ongoing genomic surveillance to monitor their occurrence and potential spread.
At the terminus of the O2 cascade, mitochondria play an important role in O2 utilisation and energy conservation, with adaptive modifications occasionally shared among hypoxia-tolerant species. Here, we sought to determine whether mitochondrial adaptations in brain tissue explain the hypoxia tolerance of New Zealand triplefin fishes (Tripterygiidae). We compared two intertidal species (Bellapiscis medius and Forsterygion lapillum), both likely adapted to hypoxia-reoxygenation exposures, and two subtidal species (F. varium and F. malcomi), which inhabit normoxic waters. To assess hypoxia tolerance, we determined loss of equilibrium (LOE) during hypoxia exposure and measured the critical O2 tension (Pcrit). Intertidal species displayed superior hypoxia tolerance as assessed by LOE and also had lower Pcrit (LOE versus Pcrit R2 = 0.99). High-resolution respirometry was used to measure mitochondrial respiration in homogenate and permeabilised fragments of brain. While a weak relationship was apparent between mitochondrial O2 binding affinity (mP50) and LOE, maximum phosphorylating O2 consumption (OxPhos) and O2 catalytic rates were strongly correlated with hypoxia tolerance. Although cytochrome-c-oxidase activity was highest in the most hypoxia-tolerant species B. medius, it was only weakly correlated with hypoxia tolerance across species. Notably, the high OxPhos capacity of intertidal species was not associated with higher whole animal resting O2 consumption, suggesting intertidal species maintain high capacity for ATP production without incurring increased basal energetic costs. While somewhat paradoxical, the low Pcrit/high OxPhos strategy of intertidal species may provide flexibility in the dynamic intertidal environment where short, severe periods of hypoxia are interspersed with high energy demand environmental conditions, including acute warming. The online version contains supplementary material available at 10.1038/s41598-025-30078-2.
Delayed graft function is a major postoperative complication after kidney transplantation, increasing the risk of both early and late graft loss. Although many preoperative, surgical, and donor-related risk factors are unmodifiable, intraoperative hypotension may contribute to reduced kidney perfusion and affect delayed graft function incidence. However, the impact of intraoperative hypotension on the risk of delayed graft function has not been rigorously examined. It was hypothesized that intraoperative hypotension is associated with increased odds of delayed graft function after kidney transplantation. This single-center retrospective cohort study included all consecutive patients with chronic renal failure who underwent first kidney transplantation from a deceased or living donor between 2013 and 2024. Combined transplant procedures were excluded. Intraoperative hypotension was quantified as the area under the curve (AUC) for a mean arterial pressure (MAP) less than 65 mmHg, capturing both duration and severity of intraoperative hypotension. The primary outcome was delayed graft function, defined as a dialysis requirement within the first postoperative week. Multivariable logistic regression, adjusting for prespecified clinically chosen recipient, intraoperative, and donor confounders, was used to assess the association between intraoperative hypotension and delayed graft function. Among 3,825 kidney transplants (68% deceased donors, 32% living donors), the median (Q1, Q3) AUC for MAP less than 65 mmHg was 12 (0, 78) mmHg·min. Delayed graft function occurred in 1,007 patients (26.3% of all cases, 37.5% deceased donors, 3.1% living donors). Each 50 mmHg·min increase in AUC for MAP less than 65 mmHg was associated with higher odds of delayed graft function (adjusted odds ratio, 1.08; 95% CI, 1.02 to 1.14; P = 0.009). Greater duration and severity of intraoperative hypotension were associated with increased incidence of delayed graft function after kidney transplantation. Although causality cannot be established, these findings highlight the potential importance of avoiding low pressure in this vulnerable population. Transplant-specific studies, including randomized trials, are needed to determine optimal intraoperative MAP targets and clarify hemodynamic strategies that may improve graft outcomes.
Oritavancin is a long-acting lipoglycopeptide with excellent bone penetration and activity against biofilm-embedded bacteria, making it a promising candidate for the treatment of bone and joint infections (BJIs). To explore its potential in this clinical context, we assessed the in vitro activity of oritavancin in comparison with other glyco-, lipo- and glycolipo-peptides against a panel of 148 multidrug-resistant staphylococcal clinical isolates, mainly collected from BJI cases. Although oritavancin showed lower overall activity than dalbavancin, resistance to oritavancin could not be reliably inferred from the activity of related antibiotics. This lack of cross-resistance highlights the need for dedicated phenotypic susceptibility testing prior to clinical use.
Perioperative three-dimensional (3D) anatomical visualization with mixed reality (MxR) may have a relevant impact on adequate carotid endarterectomy (CEA) planning compared to standard imaging studies, by highlighting patient specific anatomical features and allowing the rehearsal of the relevant surgical steps in 3D. All consecutive CEAs planned with MxR between January 2022 and July 2024 were prospectively included. Using the preoperative head and neck CT-angiography (CTA) and/or MR-angiography (MRA), skin, skull, cervical spine and vascular anatomy including plaques were segmented. The resulting 3D interactive reconstructed object was matched on the patient with MxR glasses in the operating room after patient positioning and drawing initial skin incision. The impact of 3D visualization on surgical planning and anatomical understanding was documented and usability testing was performed. Forty-nine CEAs were included. Mean 3D reconstruction preparation time was 17 ± 8 min. Mean duration of intraoperative 3D reconstruction use was 5 ± 2 min. The supervising surgeon significantly altered (shortening) the skin incision in 16 cases (33%). Higher scores were given to the domains Ease of Use and Satisfaction. CEA planning with MxR seems to have an impact on anatomical understanding for both less experienced neurosurgeons and highly experienced neurosurgeons performing more than 25 CEAs per year. Future research should focus on quantification of the benefits in surgical training and assess the impact on surgical outcomes.
Members of the Chlamydiaceae family infect a wide range of vertebrate hosts, yet their diversity and ecology in remote insular ecosystems remain poorly understood. Two previous studies screened 2274 samples from seabirds and mammals collected across five sub-Antarctic islands in the Southern Indian and Atlantic Oceans between 2017 and 2022. Here, we further characterise 424 Chlamydiaceae positive samples, including members of the Chlamydia and Chlamydiifrater genera. Chlamydiifrater spp. were detected in almost all seabird species, particularly king penguins (Aptenodytes patagonicus) and lesser sheathbills (Chionis minor), with local prevalence reaching up to 57% and 78%, respectively. In this study, phylogenetic analyses of 16S and 23S rRNA genes revealed a distinct sub-Antarctic lineage structured into three host-associated clusters, likely structured by ecological interactions and spatial segregation. Chlamydia psittaci was detected in a limited number of penguin and sheathbill samples, with ompA- and MLST-based typing revealed at least two novel genotypes. In mammals from Amsterdam Island, C. muridarum-related strains were identified in brown rats (Rattus norvegicus), while C. felis-related strains were detected in sub-Antarctic fur seals (Arctocephalus tropicalis). This is the first evidence of C. felis in a wild non-feline host, raising the issue of spillover from introduced species (here, cats (Felis catus)), to native species. These findings demonstrate that Chlamydiaceae are diverse and widespread in sub-Antarctic wildlife, encompassing both endemic and potentially introduced lineages. This emphasizes the need for ongoing surveillance, including whole-genome sequencing, to enhance our understanding of the interactions between hosts, infectious agents and the environment, and to assess potential zoonotic risks to fieldworkers in these sensitive ecosystems.
Artificial intelligence (AI) can leverage patient-generated health data (PGHD) to support pre-care processes such as triage, symptom assessment, and history-taking. Existing systematic reviews have examined AI clinical decision support, PGHD use, and AI for specific data modalities as separate domains, but none addresses their intersection for pre-care. We aimed to map AI methods and PGHD modalities, synthesize outcomes across technical, clinical, operational, user experience, and equity domains, and identify barriers to deployment and gaps in reporting. This systematic review was conducted in accordance with the PRISMA 2020 statement and prospectively registered with PROSPERO (CRD420251134235). We searched PubMed, MEDLINE, and Web of Science (January 2020-June 2025) for studies evaluating AI applications using PGHD to support pre-care processes in elective care. Risk of bias was assessed using validated tools appropriate to each study design. Narrative synthesis addressed heterogeneity across outcome domains. Twenty-one studies analyzed PGHD from free text (38%), questionnaires (33%), voice recordings (14%), wearables (10%), and images (5%). Most used classical machine learning (67%), with deep learning present in 43% of studies and large language models emerging recently (14%). Model performance appeared promising, with area under the curve values ranging from 0.64 to 0.98 (median 0.78). However, this evidence has serious limitations: risk of bias was high in 95% of studies, external validation occurred in only 6% of evaluations, and clinical outcomes were measured in just one study. Equity was assessed in only 14% of studies. No study demonstrated patient benefit or described routine clinical deployment. Current evidence establishes proof-of-concept but not proof-of-benefit. The field requires a methodological shift from algorithm development toward prospective validation, clinical outcome measurement, and equity assessment before deployment can be justified.
Practice conditions that replicate performance environments can enhance motor learning. Dyad practice, where learners alternate between physical practice and observing a partner, offers a promising approach to music training by combining motor learning principles with collaborative strategies. This study examined whether dyad practice enhanced motor learning in novice marimba players compared to individual practice. Seventy-three university-trained musicians, who were naïve to marimba playing, were assigned to one of three groups: individual practice, dyad-full (physical plus observation), or dyad-half (reduced physical plus observation). Participants completed acquisition, retention, and transfer tests using mallet endpoint error as the primary measure. Acquisition analysis revealed that only the dyad groups improved right-mallet accuracy, while the individual group showed no such gains. At retention, performance advantages were observed only in the dyad-full group, likely due to greater overall task exposure. Critically, both dyad groups outperformed the individual group on transfer, indicating superior generalization of motor skills. These findings extend dyad training principles to musical motor learning and highlight its potential to improve training efficiency and promote equity in music education by enabling shared resources and collaborative learning environments.
We analyze decay phase observations of the GOES class C6.7 flare SOL2022-08-19T20:31 by the Visible Spectropolarimeter (ViSP) on the National Science Foundation's Daniel K. Inouye Solar Telescope (DKIST). The data include the first flare-time DKIST observations of the chromospheric Ca II H 396.8 nm and H ϵ 397.0 nm spectral lines. These diagnostics have rarely been studied together during the modern era of high-resolution solar flare observations, and never at the spectral and spatial resolution of the DKIST. We directly compare DKIST spectra to state-of-the-art RADYN+RH simulations, including one heated by a nonthermal electron beam and one by in-situ thermal conduction. While certain salient properties of the spectra such as the width of H ϵ are reproduced, the models severely underestimate the width of Ca II H in the red wing and fail to reproduce the exact relative intensity of Ca II H to H ϵ . The models exhibit a range of chromospheric electron densities spanning over an order of magnitude. Unlike the modeled lower-order Balmer-series lines, we find that the width of H ϵ is not solely related to the high-density upper chromosphere; the widths and intensities are also sensitive to the deeper flare layers. We outline possible avenues towards improvement of flare models, such as a comprehensive evaluation of flare heating mechanisms in the context of both impulsive and decay phase high-resolution data.
Proximal humerus fractures (PHFs) often lead to significant morbidity and are associated with an increased risk of mortality. The aim of this study was to assess the mortality rate in patients ≥ 65 years with PHFs. Mortality risk was assessed for 30-day/in-hospital, 1-year, and 5-year follow-up, and was compared based on treatment type. A systematic review and meta-analysis was performed in accordance with PRISMA guidelines. Studies were included if they reported mortality rates at 30-day/in-hospital, 1-year, or 5-year in patients ≥ 65 years with PHFs. Data were analysed using a random-effects model to account for anticipated heterogeneity. Subgroup analysis was performed by treatment type (operative vs non-operative). Seventeen studies including 414,379 shoulders (82% female) with a mean age of 78.8 ± 2.5 reported 1-year mortality. Meta-analysis yielded a pooled 1-year mortality rate of 10% (95% CI 8.97-11.20%). Pooled 30-day/in-hospital mortality was 1.74% (95% CI 1.39-2.10%), and 5-year mortality was 36.10% (95% CI 34.50-37.70%). Mortality was lower in the operative group (7.92%, 95% CI 6.98-8.86%) compared to non-operative group (10.80%, 95% CI 9.44-12.17%), with a difference of - 2.89% (95% CI - 4.54 to - 1.23%). However, this finding should be interpreted with caution due to likely confounding by indication inherent in observational studies. For patients ≥ 65 years, PHFs are associated with high rates of mortality in the short-to-medium-term: 10.1% at 1 year and 36.1% at 5-year follow-up. These high mortality rates in patients ≥ 65 years support that PHFs are fragility fractures, and these patients could benefit from comprehensive geriatric assessment in defined orthogeriatric pathways.
The aim of this study is to describe the initial phase of the psychometric validation process, specifically focusing on the translation, cross-cultural adaptation and content validation of the Diabetes Management Knowledge Assessment Tool-17 (DMKAT-17) for Spanish nursing home settings. Methodological study of translation, cross-cultural adaptation and content validation. The translation and cultural adaptation process followed the ten steps recommended by Wild et al. Content validity was assessed using expert judgement and the modified Lawshe model proposed by Tristán-López. An expert panel evaluated the relevance of the items, and the content validity ratio and content validity index were calculated. The DMKAT-17 was reviewed by 13 experts. Based on expert ratings and qualitative feedback, items 1, 2 and 6 were removed, and wording changes were made to improve clarity and contextual appropriateness. This process resulted in a 14-item Spanish version (DMKAT-14). The scale-level content validity index was 0.841, indicating acceptable content validity based on expert judgement. This study provides a preliminary adapted Spanish version of the DMKAT-14 for the nursing home context and offers an initial basis for future psychometric evaluation.
We present the life and work of William White Cooper, with a focus on his 1850 study On the conical cornea, the earliest known multicentre epidemiological investigation of keratoconus. We contextualise Cooper's contribution within mid-19th-century ophthalmology, reassessing his findings in light of modern epidemiological knowledge. Historical research was conducted using Gallica (the digital platform of the National Library of France (BnF)) and the historical resources of The Lancet website. The keywords used were 'conical cornea' or 'keratoconus,' which were the most common names for keratoconus. William White Cooper, a leading Victorian ophthalmic surgeon and later Surgeon-Oculist in Ordinary to Queen Victoria, conducted what appears to be the first epidemiological study of keratoconus, nearly a century before the earliest study typically cited in modern literature. Drawing on data from multiple ophthalmic hospitals across England, Scotland, Ireland, and Macao, Cooper compiled prevalence figures from over 200,000 examined patients between 1814 and 1850. Prevalence rates, recalculated for comparison with modern standards, varied markedly between regions: from 0 in Edinburgh to 254.0 cases per 100,000 in Plymouth, with an overall prevalence of 85.92 per 100,000 for the United Kingdom. The highest prevalence was observed in Macao (324.15 per 100,000), leading Cooper to hypothesise that warmer climates might favor the occurrence of keratoconus. Despite the diagnostic limitations of the period, these values are strikingly close to those reported in parts of modern Europe, underscoring the scale and relevance of his pioneering work. Cooper's 1850 investigation represents the earliest known multicentre epidemiological study of keratoconus, predating modern reports by nearly a century. Despite methodological limitations inherent to the mid-19th century, his findings anticipated contemporary prevalence patterns and introduced the hypothesis of environmental influences on disease occurrence. This work not only enriches the historical record of keratoconus, but also highlights the enduring value of early clinical observation in shaping epidemiological understanding.
Leadless pacemakers have been developed to reduce complications associated with transvenous systems; however, their impact on pacing-induced cardiomyopathy (PICM) remains uncertain. This study aimed to evaluate the prevalence of PICM following leadless pacing, compared PICM risk with transvenous pacing, and assessed cardiac resynchronization therapy (CRT) upgrade. This systematic review and meta-analysis followed PRISMA guidelines. PubMed, Scopus, and ScienceDirect were searched up to January 2026. Studies reporting PICM following leadless pacing or comparing leadless and transvenous systems were included. Random-effects models estimated pooled prevalence and risk ratios (RRs), and meta-regression explored potential modifiers. Eight studies comprising 3224 patients with leadless pacing were included. The pooled prevalence of PICM following leadless pacing was 13% (95%CI: 4%-23%; I2 = 92%). In comparative analysis (5 studies; n = 6025), the risk of PICM was similar between leadless and transvenous pacing (RR 1.00; 95%CI: 0.77-1.29; I2 = 52%). Leadless pacing was associated with a lower observed rate of CRT upgrade (RR 0.56; 95%CI: 0.48-0.66; I2 = 42%), although this finding should be interpreted cautiously because it may reflect patient selection, procedural factors, and differing thresholds for CRT upgrade. Meta-regression identified baseline heart failure (HF) as a significant predictor of PICM (p < 0.0001). Leadless pacemakers demonstrate a non-inferior risk of PICM and similar safety profiles to transvenous systems, while a lower observed rate of CRT upgrade. Future studies should standardize PICM definitions and improve reporting of pacing burden, ventricular function, and patient-level outcomes.
Psychotic disorders are marked by heterogeneity in symptoms and treatment response, yet efforts to develop clinically useful predictive models through neuroimaging have been limited. Although MRI is gold standard for neuroimaging in psychosis, CT is frequently used in psychiatric care due to accessibility and cost. Advances in artificial intelligence, particularly deep learning, offer the potential for extracting meaningful information from CT brain scans. We conducted a systematic review of peer-reviewed studies applying machine learning, including deep learning to CT brain imaging in dementia or psychotic disorders. Six databases were searched from inception to Nov. 22, 2024. Studies were included if they involved deep or machine learning models using CT scans for diagnostic or prognostic modelling. Risk of bias was assessed using PROBAST + AI; reporting quality was evaluated with TRIPOD-AI or CLAIM. Seven studies met inclusion criteria: one related to psychosis and six to dementia. All studies included used deep learning models for classification or segmentation. Sample sizes ranged from 65 to 917. All predictive studies were rated as high risk of bias. TRIPOD-AI adherence was limited with most items poorly reported (16-21/27). Segmentation studies had low-to-moderate CLAIM adherence with limitations in external validation, code availability and reproducibility. Only one study to date has applied deep learning to CT imaging in psychosis. Research in dementia offers transferable insights. From a translational viewpoint, future work should prioritise the construction of large and well characterised psychosis cohorts including medical imaging, clinical and functional outcome prediction, external validation and transparent methodology to support clinical translation.