Since the COVID-19 outbreak, global attention toward infectious diseases has intensified, and many experts anticipate that the next pandemic may stem from multidrug-resistant (MDR) bacteria, often termed "Superbugs". Among them, methicillin-resistant Staphylococcus aureus (MRSA) represents one of the most widespread MDR bacterium responsible for severe nosocomial infections. As the emergence of new resistant strains accelerates due to overuse and misuse of antibiotics, development of anti-pathogenic therapeutics has gained significant interest. In this study, we explored the anti-biofilm activity of Artemisia fukudo (Af), a halophyte abundant in bioactive metabolites. The n-butanol (n-BuOH) fraction of Af markedly inhibited MRSA biofilm formation, independent of bacterial growth inhibition or biofilm degradation. Transcriptional profiling by qRT-PCR revealed that expression of adhesion-related genes was notably downregulated. In A549 cell line infection assay, Af n-BuOH fraction treatment significantly reduced MRSA attachment and internalization. Furthermore, in a Caenorhabditis elegans infection model, Af n-BuOH fraction exposure extended host life-span, suggesting attenuation of bacterial virulence. Taken together, our findings demonstrate that Af-derived compounds interfere with initial adhesion process crucial for MRSA biofilm development and host colonization. This study highlights the therapeutic potential of halophyte-derived natural products as promising anti-virulence alternatives to conventional antibiotics for controlling infections caused by multidrug-resistant pathogens.
To investigate variations in post-operative cataract surgery instructions among eye health workers in Tanzania and identify areas requiring standardization. A cross-sectional survey was conducted among 142 eye health workers across all health workers providing cataract surgery or post-operative care in Tanzania. The survey assessed counselling practices, timing recommendations for resuming 23 daily activities, medication prescription patterns, and follow-up protocols. Variation indices (VI) were calculated to quantify the degree of disagreement among providers using the formula: VI = 1 - (modal frequency/total responses). Variation was classified as low (VI < 0.40), moderate (0.40-0.60), high (0.60-0.70), or very high (> 0.70). Survey respondents included ophthalmology residents (28%), consultant ophthalmologists (22%), ophthalmic nursing officers (17%), assistant medical officers (13%), and optometrists (12.0%). Only 30%of providers routinely provide written post-operative instructions to patients. Substantial variations existed across most activities examined: watching television (VI = 0.775), computer use (VI = 0.761), smartphone use (VI = 0.754), bending for prayers (VI = 0.725), and sexual activity (VI = 0.690). Recommendations for activity resumption ranged from Day 1 to 6 weeks post-operatively (a 41-day span) for most activities. Good consensus existed only for phone use (59.2% allow Day 1, VI = 0.323) and eating normal diet (48.6% allow Day 1, VI = 0.434). Provision of written instructions varied significantly by professional designation (χ²=28.85, p = 0.0013), but activity recommendations showed no significant correlation with designation, years of experience, or surgical volume. The modal number of follow-up visits was 4 (32.4%), with the last visit most commonly scheduled at 8 weeks (30.3%). Substantial variations in post-operative cataract surgery instructions reflect the absence of evidence-based guidelines rather than individual provider factors. The critical deficit in written instruction provision (only 30%) and wide variation in activity restrictions have significant implications for patient compliance, quality of life, and economic productivity. Development of standardized, evidence-based, culturally appropriate guidelines is urgently needed for Tanzania and similar settings in sub-Saharan Africa.
Cognitive impairment is a significant health concern among older adults, highlighting the need for non-pharmacological interventions, such as mind-body exercises. However, a comprehensive synthesis of the effects of various traditional Chinese exercises (TCEs) on cognitive function in older adults is lacking. A systematic review and meta-analysis of randomised controlled trials (RCTs) was conducted. Six databases were searched from inception to 2 May 2024 for studies examining the effects of TCEs on cognitive outcomes in adults aged 60 years and older. Studies were included if they were RCTs involving TCEs and reported outcome measures for global cognition, or individual cognitive domains. Twenty-eight RCTs with a total of 2297 participants were included. Meta-analysis revealed that TCEs led to significant improvements in global cognition: Montreal Cognitive Assessment [mean differences (MD) = 1.67; 95% confidence interval (CI): (1.20, 2.14)], Mini-Mental State Examination [MD = 0.76; 95% CI: (0.04, 1.48)]; executive function: Trail Making Test (B-A) [MD = -7.96; 95% CI: (-15.34, -0.59)], Category Fluency for Animals [MD = 2.96, 95% CI (2.08, 3.85)]; working memory: Digit Span-Backwards [MD = 0.48; 95% CI: (0.07, 0.90)]; processing speed: Digit Symbol Coding [MD = 4.16; 95% CI: (1.82, 6.50)]; memory function: Memory Quotient [MD = 13.13; 95% CI: (4.06, 22.20)], Auditory Verbal Learning Test: immediate recall [MD = 1.13; 95% CI: (0.07, 2.20)], short-term delayed recognition [MD = 0.80; 95% CI: (0.28, 1.32)] and long-term delayed recognition [MD = 1.38; 95% CI: (0.68, 2.09)]. TCEs are effective in improving cognitive function in older adults, particularly in domains such as global cognition, executive function, working memory, processing speed and memory function. However, given the methodological limitations and heterogeneity of the included studies, these findings require confirmation in further large-scale, high-quality RCTs.
This study aims to investigate the mechanism by which extract of Dendrobium officinale leaves (EDL) extends the lifespan of Caenorhabditis elegans. Untargeted metabolomics and network pharmacology analyses revealed that EDL primarily contains active components such as fatty acids, flavonoids, and polyphenols, which are predicted to potentially modulate pathways including MAPK, AMPK, mTOR, and longevity-related signaling pathways. Experimental results showed that 2 mg/mL EDL significantly extended the mean lifespan of nematodes by 11.4%, enhanced pharyngeal pumping rate and muscular endurance, but reduced brood size. EDL treatment also significantly decreased lipid droplet accumulation, cell apoptosis, and lipofuscin levels. Transcriptomic analysis indicated that EDL regulated the expression of multiple genes related to energy metabolism, particularly activating longevity-regulating pathways and the AMPK signaling pathway. RT-qPCR results demonstrated that EDL significantly increased the mRNA level of sod-3 in C.elegans. In conclusion, EDL may upregulate the expression of the sod-3 gene via the DAF-16/SOD-3 axis, thereby extending lifespan in C. elegans, providing a scientific basis for the high-value utilization of Dendrobium officinale leaves.
Although exposure of Anopheles mosquitoes to insecticide-treated vector control tools is not always lethal, the sublethal effects of these insecticides on their life-history traits remain poorly explored. Therefore, this study examined the impact of sublethal exposure to broflanilide, chlorfenapyr and deltamethrin on longevity; blood meal acceptance; viable egg production; and the proportion of females with viable eggs in insecticide-resistant An. gambiae s.l. populations from Tiassalé, Côte d'Ivoire. The sublethal effects of broflanilide, chlorfenapyr and deltamethrin were assessed on 3-5-day-old adult female An. gambie s.l. from the field collected Tiassalé strain (F0), using the insecticide-susceptible Kisumu strain as reference, following standardized World Health Organization (WHO) bottle bioassay procedures. For each insecticide, the lethal dose causing 20% mortality (LD20) was determined through dose-response analysis and then subsequently applied in treated bottles. Post-exposure, longevity, blood-feeding success, egg viability and the proportion of ovipositing females were recorded. Comparisons were made between the control and LD20 treatment groups. Sublethal exposures produced distinct effects depending on both the mosquito strain and the insecticide type. Broflanilide significantly reduced longevity in the Tiassalé population (P < 0.0001), whereas chlorfenapyr and deltamethrin had stronger effects on the Kisumu strain. Deltamethrin exposure notably impaired blood-feeding behaviour, reducing feeding success by 25.5% in Kisumu and 19.5% in Tiassalé. Reproductive parameters were also affected: both chlorfenapyr and broflanilide reduced viable egg production and the proportion of females producing viable eggs in both strains. In contrast, deltamethrin showed a more limited impact on reproduction. In the Tiassalé strain, the proportion of females producing viable eggs dropped to 41.5% following chlorfenapyr exposure, compared with 65.7% in unexposed individuals. These findings demonstrate that sublethal doses of insecticides can adversely affect reproductive success and blood-feeding behaviour in both susceptible and resistant Anopheles mosquitoes, potentially reducing their vectorial capacity. This study underscores the need to systematically account for sublethal effects when evaluating insecticides in vector control programs, particularly in settings where resistance is widespread among malaria vectors.
Percutaneous peritoneal dialysis (PD) catheters demonstrate short-term outcomes comparable to surgically placed catheters but remain underutilized because of concerns regarding long-term durability and limited follow-up data. We retrospectively reviewed 117 PD catheters in 90 patients who initiated PD between 2014 and 2020 at a freestanding home dialysis unit, with follow-up through December 2022. Eighty-three catheters were placed percutaneously by interventionalists and 34 laparoscopically for suspected hernias, prior abdominal surgery, or refractory peritonitis. The primary outcome was catheter survival, defined as time from PD training initiation to PD discontinuation. Secondary outcomes included catheter-related adverse events not requiring removal. The mean age was 46.5 ± 14 years; 38% were female, 76% Hispanic, mean BMI was 30 ± 7 kg/m2, and diabetes accounted for 63% of kidney failure cases. Baseline characteristics were similar between groups except for lower BMI in the percutaneous cohort. Median catheter longevity was 20.3 months (IQR 6.8-36.0) for percutaneous placement and 17.0 months (IQR 7.2-30.8) for surgical placement. PD-related infections were the leading cause of catheter removal in both groups, while the rates of major and minor mechanical complications were comparable. To our knowledge, this is among the largest contemporary real-world cohorts evaluating long-term outcomes of percutaneous PD catheters, with follow-up extending beyond 5 years, and it addresses an important evidence gap. Percutaneous PD catheters demonstrated long-term survival and complication rates comparable to those of surgically placed catheters. These findings support broader adoption of percutaneous catheter placement to facilitate timely PD initiation and patient-centered modality selection.
The rapid growth of the older adult population and the increasing burden of chronic disease require coordinated, prevention-focused models of care. Lifestyle medicine (LM) provides evidence-based therapeutic interventions that target nutrition, physical activity, restorative sleep, stress management, social connection, and avoidance of risky substances. At the same time, the Age-Friendly Health Systems initiative promotes the 4Ms framework, which includes What Matters, Medication, Mentation, and Mobility, to optimize outcomes for older adults. Although these approaches are conceptually aligned, they are often implemented independently. This manuscript describes an interprofessional framework integrating LM and the 4Ms to advance whole-person, age-friendly care. The framework positions What Matters at the center, organizes care through the remaining domains (Medication, Mentation, and Mobility), and embeds the 6 lifestyle pillars as modifiable drivers of health. Implementation across interdisciplinary educational initiatives-including case conceptualizations, Project ECHO (Extension for Community Healthcare Outcomes) participation, community health worker training, internships, an asynchronous LM course, and a culinary medicine teaching kitchen-demonstrates feasibility in academic and community settings. Descriptive evaluation findings indicate interdisciplinary engagement, high satisfaction, perceived relevance to practice, and reported improvements in confidence and clinical application. Integrating lifestyle medicine within interprofessional structures offers a scalable strategy to strengthen workforce development and support healthy longevity.
The current study seeks to examine rational motivational variables central to self-determination theory (i.e., perceived competence, family social support, friend social support, autonomous motivation, controlled motivation, and amotivation) as moderators of the relationship between automatic motives (i.e., momentary affective states, fatigue, and energy) and physical activity (moderate-to-vigorous physical activity and sedentary behavior). We conducted a 20-day ecological momentary assessment (EMA) study, in which 100 adolescents aged 13-18 years old were recruited locally February 2016 to March 2017 and were asked to indicate baseline social support, motivation, and competence for physical activity. Subsequently, participants wore an Actigraph accelerometer 24 h per day and answered EMA surveys assessing automatic motives 4 times per day using time-based signaling. There was a significant interaction between within-person positive affect and amotivation as a predictor of moderate-to-vigorous physical activity (MVPA) (b = -0.02, p < 0.05) with 95% CI [-0.04, -0.01] and sedentary time (b = 0.10, p < 0.01) with 95% CI [0.04, 0.16]. There was also a significant interaction between within-person negative affect and amotivation as a predictor of sedentary time (b = -0.08, p < 0.05) with 95% CI [-0.14, -0.01]. Within-person fatigue interacted with friend social support (b = 0.05, p < 0.01) with 95% CI [0.02, 0.08], amotivation (b = 0.03, p < 0.05) with 95% CI [0.003, 0.06], and controlled motivation (b = -0.03, p < 0.01) with 95% CI [-0.05, -0.01] in relation to MVPA. Overall, findings from this study suggest that rational and automatic motives are intertwined and should be explored together as targets for physical activity intervention efforts.
This longitudinal cohort study used data from the Chinese Longitudinal Healthy Longevity Survey (CLHLS) (2005-2018) to examine lifecourse socioeconomic status (SES), leisure activity, and cognitive impairment in 6,289 adults aged ≥65 without baseline impairment. Over 6.42 years, 1,818 (28.9%) developed impairment. Both childhood SES (HR=0.939) and adulthood SES (HR=0.925) significantly reduced risk. Leisure activity mediated 17.8% of childhood SES effect and 34.9% of adulthood SES effect, suggesting higher lifecourse SES protects against cognitive impairment partly through leisure activity.
Microplastics originating from pellets, paints, fragmented macroplastics, textiles, tire wear, and personal care products enter sewage and can aggregate with viruses during treatment. After sludge application, these aggregates may infiltrate soils and enter groundwater, yet their aggregation mechanisms and effects on virus survival and transport remain unclear. To address this gap, we conducted a laboratory study to examine the effect of microplastics on virus persistence and transport in groundwater. Batch experiments were conducted by mixing the PRD1 bacteriophage (a surrogate for adenovirus) with microplastics in groundwater at various temperatures. Column experiments using saturated quartz sand were performed to evaluate the effect of microplastics on virus transport in groundwater. Microplastic particles were quantified using solid-phase cytometry, while PRD1 was enumerated using both molecular and culture-based methods. Experimental data were analyzed using the HYDRUS-1D 2-site attachment-detachment model and colloid filtration theory. Our experimental findings suggest that microplastics significantly influence viral stability and transport in groundwater. Batch experiments revealed a marked decrease in the persistence of infective viruses in the presence of microplastics, reducing viral longevity in the environment. On the other hand, co-transport experiments showed that microplastics promoted the transport of both total and infective viruses through saturated quartz sand. This dual role underscores the complex influence of microplastics in groundwater: while they may reduce virus viability, their ability to enhance viral mobility represents a significant pathway for virus dissemination. These findings highlight the need to consider microplastics not only as pollutants but also as vectors that can potentially increase the risk of waterborne transmission and compromise groundwater safety.
Asymmetry in white matter is believed to give rise to the brain's capacity for specialized processing and is involved in the lateralization of various cognitive processes, such as language and visuo-spatial reasoning. Although studies of white matter asymmetry have been previously documented, they have often been constrained by limited age ranges, sample sizes, or the scope of the tracts and structural features examined. While normative lifespan charts for brain structures are emerging, comprehensive charts detailing white matter asymmetries across numerous pathways and diverse structural measures have been notably absent. This study addresses this gap by leveraging a large-scale dataset of 35,120 typically developing and aging individuals, ranging from 0 to 100 years of age, from 50 primary neuroimaging studies. We generated comprehensive lifespan trajectories for 30 lateralized association and projection white matter tracts, examining six distinct microstructural and macrostructural features of these pathways. Our findings reveal that: (1) asymmetries are widespread across the brain's white matter and are present in all 30 pathways; (2) for a given pathway, the degree and direction of asymmetry differ between features of tissue microstructure and pathway macrostructure; (3) asymmetries vary across and within pathway types (association and projection tracts); and (4) these asymmetries are not static, following unique trajectories across the lifespan, with distinct changes during development, and a general trend of becoming more asymmetric with increasing age (particularly in later adulthood) across pathways. This study represents the most extensive characterization of white matter asymmetry across the lifespan to date, charting how lateralization patterns emerge, mature, and change throughout life. It provides a foundational resource for understanding the principles of white matter organization from early to late life, its relation to functional specialization and inter-individual variability, and offers a key reference for interpreting deviations during healthy development and aging as well as those associated with clinical populations.
The demands of competing in the Olympic games is remarkably similar to that of surgeon in theatre. Both require sustained precision, high cognitive load, emotional regulation, physical endurance, and the weight of outcomes that matter profoundly.Other high-performance domains, such as elite sport, aviation, and the military, have long recognised that peak execution comes from deliberate investment in human performance science: training body and mind, integrating recovery, applying technology, and employing coaching and human performance strategy to optimise outcomes. Athletes systematically invest in programmed and periodised conditioning, physiological monitoring, recovery, nutrition, and psychological resilience. Their success depends on the integration of physiology, psychology, and environment.
Cognitive impairment is a frequent outcome of chronic viral infections linked to premature aging, including HIV. The mechanisms underlying this decline remain poorly understood. Here, we identify pro-inflammatory glycan degradation, characterized by loss of sialic acid and galactose, both hallmarks of premature aging, as a key contributor to HIV-associated cognitive impairment (HIV-CI). We analyzed two cohorts of people with HIV, with and without HIV-CI, and tested causality through intervention studies in two complemetary mouse models of virally mediated inflammation and cognitive deceline. Degradative glycomic changes were enriched in people with HIV with cognitive impairment, particularly females, and correlated with worse cognitive performance. In both a humanized mouse model of HIV and EcoHIV model, a complementary model that enables cognitive testing, pharmacological inhibition of glycan degradation with sialidase inhibitors prevented virally induced inflammation, immune activation, accelerated aging, and memory deficits. These findings implicate glycan degradation as a contributor to inflammation and cognitive impairment in HIV and highlight glycan preservation as a promising strategy to mitigate inflammation, premature aging, and cognitive decline during viral infections. This study was funded by the National Institutes of Health (NIH).
Heart failure (HF) increases in prevalence with age. For patients with advanced HF, both durable left ventricular assist devices (LVADs) and heart transplantation (HT) can improve longevity and quality of life. However, comparing optimal outcomes between the 2 therapies in middle-aged and older patients who are eligible for both remains controversial. This study aims to report survival and adverse events in middle-aged (50-64 years of age) and older (≥65 years of age) adults with advanced HF who received the HeartMate 3 (HM3) (Abbott) LVAD or were listed for or underwent HT. The authors analyzed patients from the MOMENTUM 3 IDE (Multi-Center Study of MagLev Technology in Patients Undergoing MCS [Mechanical Circulatory Support] Therapy with HeartMate 3 IDE [Investigational Device Exemption] Protocol; and MOMENTUM 3 CAP [Continued Access Protocol]) HM3 cohort (N = 1,763) and the UNOS (United Network for Organ Sharing) registry (N = 5,336) from 2014 to 2018, by using propensity score matching to adjust for baseline differences. Outcomes included 2-year survival from treatment or listing and 1-year major adverse events (stroke, renal dysfunction, infection-related hospitalization). After matching, HT demonstrated higher 2-year survival when measured from treatment (middle-aged group: 90.7% vs 83.8%; HR: 1.76; P = 0.0004; older group: 87.5% vs 77.7%; HR: 1.89; P < 0.0001). However, when incorporating the waitlist period, HM3 survival was higher compared with survival free from delisting resulting from deterioration in middle-aged HT candidates (83.0% vs 75.0%; HR: 0.62; P < 0.0001). Among older adults, accounting for the waitlist resulted in numerically higher HM3 survival relative to HT candidates (76.6% vs 72.2%; HR: 0.81; P = 0.064). The 2-year survival was higher post-HT compared with HM3 use; however, when including pre-HT waitlist time, HM3 therapy demonstrated higher survival than survival free from delisting resulting from deterioration in HT candidates. These findings underscore the importance of considering wait time when discussing advanced HF therapies. (Multi-Center Study of MagLev Technology in Patients Undergoing MCS [Mechanical Circulatory Support] Therapy with HeartMate 3 IDE [Investigational Device Exemption] Protocol [MOMENTUM 3 IDE]; NCT02224755; and Continued Access Protocol [MOMENTUM 3 CAP]; NCT02892955).
Clonality, the process of vegetative reproduction through belowground organs (rhizomes, stolons), occurs in about half of all plant species. It influences key ecological and evolutionary phenomena, including effective population size, meiosis frequency and genet longevity, which may affect diversification rates. This study investigates how clonality impacts diversification in angiosperms by comparing clonal, mixed and non-clonal genera. Using genus-level phylogeny and data on clonal status of 16,465 species across 2997 genera, we estimated speciation and net diversification rates for each genus with MoM, DR and BAMM. Our results reveal lower diversification rates in clonal genera in non-phylogenetic models, consistent with the hypothesis that clonality constrains diversification. This effect weakens when accounting for phylogenetic non-independence but remains significant overall. We show that monocots show a slightly stronger effect of clonality on diversification than eudicots. Our findings suggest that clonality may limit long-term diversification in angiosperms, influencing evolutionary dynamics where clonal reproduction predominates.
Although multidomain interventions, which simultaneously address several risk factors are an evidence-based strategy for dementia prevention, their implementation status and factors driving their adoption by local governments remain unclear. This implementation gap is critical, as limited uptake on dementia prevention programs may restrict opportunities to reduce dementia risk at the population level. This study aimed to clarify the landscape of dementia prevention activities across Japanese municipalities and identify factors associated with the intention to implement comprehensive multidomain programs. A nationwide cross-sectional survey was conducted, targeting all 1,741 municipalities in Japan. A structured questionnaire was developed and used to assess the implementation of 12 World Health Organization (WHO)-recommended prevention items as well as the municipalities' intention to adopt a multidomain program. A multinomial logistic regression analysis was performed to identify factors associated with a high adoption intention (Active Group) compared to a clear non-adoption intention (Non-Adoption Group), adjusting for municipal characteristics. Of 941 included municipalities (54.0% response rate), current prevention efforts were predominantly focused on cognitive, social, and physical activities, with less emphasis on cardiovascular risk management. The strongest predictor of adoption intention was the implementation of measures to improve residents' health literacy (relative risk ratio [RRR] = 2.8, 95% confidence interval [CI]: 1.2-6.5). Other significant factors included prior experience with multidomain programs (RRR = 1.4, 95% CI: 1.2-1.7), awareness of the WHO guidelines (RRR = 1.4, 95% CI: 1.0-2.0), and the number of currently implemented items (RRR = 1.2, 95% CI: 1.1-1.3). Structural factors such as staffing levels were not significant. The adoption of evidence-based dementia prevention programs by the Japanese municipalities appears to depend more on programmatic readiness and a commitment to public health communication than on structural capacity alone. These findings highlight the importance of strengthening readiness and health literacy to support municipalities in translating evidence-based dementia prevention strategies into practice and advancing population-level risk reduction.
Mechanical malfunction remains one of the most common causes of inflatable penile prosthesis failure, yet long-term data on the specific causes, failure locations, and timing remain limited. We aim to elucidate the mechanism, location, and timing of mechanical breakdown of the Coloplast Titan Touch implants. This is a retrospective review of all patients at a single surgical center performed by a high-volume single surgeon between January 2013 and December 2025. Only Coloplast Titan implants with Touch pumps were included in this study. Sites of mechanical failure were categorized into location of tubing fracture, cylinder, or reservoir leak or pump malfunction. The primary outcome was the incidence and etiology of mechanical failure requiring surgical revision, and secondary outcomes included anatomic location of failure and time to mechanical failure requiring reoperation. A total of 3197 penile prostheses were implanted using the no-touch technique. In the Coloplast Touch group (n = 1907), 214 patients (7.6%) required reoperation or replacement, with 149 cases (69.6%) due to mechanical failure. Median time to reoperation was 59.1 months. Kink-resistant tubing (KRT) malfunction was the leading cause. Most tubing fractures (77%) occurred at the connection between the KRT and strain relief boot near the scrotal pump. Other fracture sites included the cylinder junction (13.7%), reservoir junction (5%), and KRT-KRT connections (2.9%). Additionally, 34% of failures involved sidewall erosion of the KRT without complete fracture. Identification of recurrent anatomic failure points may inform surgical technique modifications and device design improvements aimed at reducing mechanical failure rates and extending implant longevity. Strengths include a large single-institution cohort with long-term follow-up and uniform surgical technique. Limitations include the retrospective design and single-surgeon experience, which may limit generalizability. Characterizing the timing and anatomic site of failure enables us to generate hypotheses regarding the underlying mechanisms of malfunction to target modifications to our surgical technique with the goal of extending the durability and overall longevity of the Coloplast Titan multicomponent penile prosthesis.
Schizophrenia spectrum disorders (SSD) are associated with increased risks of criminal behavior, especially if mediated by factors such as substance use. However, it remains unclear whether these factors retain their predictive relevance once broader social and systemic conditions are considered. To date, comparisons between forensic (FPP) and general psychiatric (GPP) SSD patients that systematically test the weight of these factors in complex contexts are scarce. We sought to evaluate whether established clinical risk factors for criminal behavior hold explanatory power once embedded in wider contextual frameworks. Group membership was used as a proxy for such forensic trajectories. A retrospective study was conducted using data from 740 patients (370 FPP, 370 GPP) diagnosed with SSD receiving treatment at one institution in Switzerland. Several machine learning algorithms were tested. Gradient Boosting emerged as the most suitable model. Performance metrics such as balanced accuracy, area under the curve (AUC), sensitivity, and specificity were used for model evaluation. Key predictive variables were ranked based on their influence. Gradient Boosting achieved a balanced accuracy of 77.5% and an AUC of 0.85 (analysis excluding item 'olanzapine-equivalent dose at discharge', which was identified as a potential downstream marker of institutional placement; primary model with all items: 81.6% and 0.88, respectively), outperforming other algorithms in discriminating between the groups. Notable predictors of a forensic-psychiatric course included social isolation across life span and limited mental health care system integration, while psychopathology did not emerge as a relevant predictor. When comprehensively comparing forensic and general psychiatric SSD patients, social isolation, antipsychotic dosage, and mental health system integration emerge as the primary discriminators, overshadowing well established risk factors. Preventing forensic pathways in SSD requires strengthening social networks and system integration, marking a paradigm shift away from symptom-centered risk models.
Dementia poses a growing global public health burden, particularly in low- and middle-income countries where cognitive screening coverage remains limited. Current risk estimation tools often depend on cognitive testing or biomarkers, restricting their applicability in community and primary care settings. To establish and validate a data-driven analytical framework for developing a cognitive-testing-free dementia risk estimation tool (Cog-Free) using routinely collected health examination data. For this prospective cohort study, we developed Cog-Free, an internet-based dementia risk estimation tool, using 38 Least Absolute Shrinkage and Selection Operator-selected risk-associated variables and the optimal machine-learning algorithm (logistic regression). The optimal algorithm was internally validated with bootstrap resampling and externally tested in the Chinese Longitudinal Healthy Longevity Survey cohort. The tool was trained and internally validated in 2962 dementia-free adults aged ≥ 65 years (2018-2024), and its performance was compared with three established cognitive-testing-free tools. Cog-Free achieved the highest area under the receiver operating characteristics curve in the internal validation set (0.86 [95% confidence interval (CI) 0.82-0.89]) with an accuracy of 0.81 (95% CI 0.78-0.83), sensitivity 0.78 (95% CI 0.68-0.85) and specificity 0.81 (95% CI 0.78-0.84), significantly outperforming three existing tools (DeLong's test, p < 0.001). Several previously under-recognized risk-associated variables for dementia were identified, such as right-hand grip strength, cognitive activity, having worse memory than peers, nighttime awakenings and income satisfaction. Cog-Free provides a data-driven, cognitive-testing-free and easily accessible approach for early dementia risk screening using routine health data. Its performance and web-based design suggest potential utility as a pre-screening and risk stratification tool within community health systems, including settings with limited access to cognitive testing.
Self-control, the ability to resist an immediate reward for a more beneficial delayed outcome, is an adaptive skill underlying decision-making. While widely studied in non-human primates and birds, its evolution remains debated. Factors such as brain size, metabolic rate, longevity, social complexity, or foraging ecology may shape self-control across species. To investigate further the link between these factors and self-control, we compared two domesticated ungulates, sheep (Ovis aries, n = 7) and goats (Capra hircus, n = 7), in a delay of gratification task. These species mostly differ on their level of social cohesion and foraging ecology but share a relatively similar evolutionary and domestication history. In our study, sheep waited for 54.3 ± 15.1 s while goats waited for 62.9 ± 13.8 s (group level mean ± SD). Some individuals from both species delayed gratification for up to 80 s. The moderate higher success rate of goats may relate to their feeding ecology as dispersed foragers or to their social flexibility compared to sheep. The two species adapted their decision according to different parameters, such as the duration of the upcoming delay or the relative values of the rewards and engaged in distraction behaviours to increase their success rate in waiting, indicating that they share common cognitive strategies. These findings suggest that factors such as social complexity or foraging ecology may shape self-control in these domesticated species.