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The growing concern over cyber risk has become a pivotal issue in the business world. Firms can mitigate this risk through two primary strategies: investing in cybersecurity practices and purchasing cyber insurance. Cybersecurity investments reduce the compromise probability, while cyber insurance transfers potential losses to insurers. This study employs a network model for the spread of infection among interconnected firms and investigates how each firm’s decisions impact each other. We analyze a non-cooperative game in which each firm aims to optimize its objective function through choices of cybersecurity level and insurance coverage ratio. We find that each firm’s cybersecurity investment and insurance purchase are strategic complements. Within this game, we derive sufficient conditions for the existence and uniqueness of Nash equilibrium and demonstrate its inefficiency. These theoretical results form the foundation for our numerical studies, allowing us compute firms’ equilibrium decisions on cybersecurity investments and insurance purchases across various network structures. The numerical results shed light on the impact of network structure on equilibrium decisions and explore how varying insurance premiums influence firms’ cybersecurity investments.
While early intervention in psychosis (EIP) programs have been increasingly implemented across the globe, many initiatives from Africa, Asia and Latin America are not widely known. The aims of the current review are (a) to describe population-based and small-scale, single-site EIP programs in Africa, Asia and Latin America, (b) to examine the variability between programs located in low-and-middle income (LMIC) and high-income countries in similar regions and (c) to outline some of the challenges and provide recommendations to overcome existing obstacles.
Methods
EIP programs in Africa, Asia and Latin America were identified through experts from the different target regions. We performed a systematic search in Medline, Embase, APA PsycInfo, Web of Science and Scopus up to February 6, 2024.
Results
Most EIP programs in these continents are small-scale, single-site programs that serve a limited section of the population. Population-based programs with widespread coverage and programs integrated into primary health care are rare. In Africa, EIP programs are virtually absent. Mainland China is one of the only LMICs that has begun to take steps toward developing a population-based EIP program. High-income Asian countries (e.g. Hong Kong and Singapore) have well-developed, comprehensive programs for individuals with early psychosis, while others with similar economies (e.g. South Korea and Japan) do not. In Latin America, Chile is the only country in the process of providing population-based EIP care.
Conclusions
Financial resources and integration in mental health care, as well as the availability of epidemiological data on psychosis, impact the implementation of EIP programs. Given the major treatment gap of early psychosis in Africa, Latin America and large parts of Asia, publicly funded, locally-led and accessible community-based EIP care provision is urgently needed.
We examine the gravity-driven flow of a thin film of viscous fluid spreading over a rigid plate that is lubricated by another viscous fluid. We model the flow over such a ‘soft’ substrate by applying the principles of lubrication theory, assuming that vertical shear provides the dominant resistance to the flow. We do so in axisymmetric and two-dimensional geometries in settings in which the flow is self-similar. Different flow regimes arise, depending on the values of four key dimensionless parameters. As the viscosity ratio varies, the behaviour of the intruding layer ranges from that of a thin coating film, which exerts negligible traction on the underlying layer, to a very viscous gravity current spreading over a low-viscosity, near-rigid layer. As the density difference between the two layers approaches zero, the nose of the intruding layer steepens, approaching a shock front in the equal-density limit. We characterise a frontal stress singularity, which forms near the nose of the intruding layer, by performing an asymptotic analysis in a small neighbourhood of the front. We find from our asymptotic analysis that unlike single-layer viscous gravity currents, which exhibit a cube-root frontal singularity, the nose of a viscous gravity current propagating over another viscous fluid instead exhibits a square-root singularity, to leading order. We also find that large differences in the densities between the two fluids give rise to flows similar to that of thin films of a single viscous fluid spreading over a rigid, yet mobile, substrate.
During the investigation of parasitic pathogens of Mytilus coruscus, infection of a Perkinsus-like protozoan parasite was detected by alternative Ray's Fluid Thioglycolate Medium (ARFTM). The diameter of hypnospores or prezoosporangia was 8–27 (15.6 ± 4.0, n = 111) μm. The prevalence of the Perkinsus-like species in M. coruscus was 25 and 12.5% using ARFTM and PCR, respectively. The ITS1-5.8S-ITS2 fragments amplified by PCR assay had 100% homology to that of P. beihaiensis, suggesting that the protozoan parasite was P. beihaisensis and M. coruscus was its new host in East China Sea (ECS). Histological analysis showed the presence of trophozoites of P. beihaiensis in gill, mantle and visceral mass, and the schizonts only found in visceral mass. Perkinsus beihaiensis infection led to inflammatory reaction of hemocyte and the destruction of digestive tubules in visceral mass, which had negative effect on health of the farmed M. coruscus and it deserves more attention.
Ridge B is one of the least studied areas in Antarctica but has been considered to be a potential location for the oldest ice on Earth. Among important parameters for calculating where very old ice may exist, geothermal heat flux (GHF) is critical but poorly understood. Here, GHF is determined by quantifying the transitions between dry and wet basal conditions using a radioglaciological method applied to airborne radio-echo sounding data. GHF is then constrained by a thermodynamic model matched to the transitions. The results show that GHF in Ridge B varies locally and ranges from 48.5 to 65.1 mW m−2, with an average value of 58.0 mW m−2, which is consistent with the current known GHF constrained by subglacial lakes and derived from Vostok ice core temperature measurements. Our work highlights the value of considering local GHF when locating the oldest ice in this potential region or other regions.
Social determinants of health (SDoH), such as socioeconomics and neighborhoods, strongly influence health outcomes. However, the current state of standardized SDoH data in electronic health records (EHRs) is lacking, a significant barrier to research and care quality.
Methods:
We conducted a PubMed search using “SDOH” and “EHR” Medical Subject Headings terms, analyzing included articles across five domains: 1) SDoH screening and assessment approaches, 2) SDoH data collection and documentation, 3) Use of natural language processing (NLP) for extracting SDoH, 4) SDoH data and health outcomes, and 5) SDoH-driven interventions.
Results:
Of 685 articles identified, 324 underwent full review. Key findings include implementation of tailored screening instruments, census and claims data linkage for contextual SDoH profiles, NLP systems extracting SDoH from notes, associations between SDoH and healthcare utilization and chronic disease control, and integrated care management programs. However, variability across data sources, tools, and outcomes underscores the need for standardization.
Discussion:
Despite progress in identifying patient social needs, further development of standards, predictive models, and coordinated interventions is critical for SDoH-EHR integration. Additional database searches could strengthen this scoping review. Ultimately, widespread capture, analysis, and translation of multidimensional SDoH data into clinical care is essential for promoting health equity.
This study examines the pursuit-evasion game involving unmanned aerial vehicles (UAVs), with a specific focus on the scenario of N-pursuers-one-escapee. The primary objective is to develop an optimal strategy for the escapee when the pursuers possess superior capabilities. To obtain this objective, we conduct the following study. Firstly, to enhance realism, a non-cooperative differential game model is formulated, incorporating multiple motion characteristics, including aerodynamics, overloading, and imposed constraints. Secondly, the end-value performance index is subsequently converted to an integral one, simplifying the solution process of the Hamilton-Jacobi-Bellman (HJB) equation. An iterative method is utilised to determine the covariates using the Cauchy initial value problem, and its convergence and uniqueness are established. The optimal avoidance strategy is subsequently derived from the covariates. Finally, the superiority of the proposed strategy is validated through simulation experiments and compared to three advanced optimal avoidance strategies. A total of 1,000 anti-jamming simulation experiments are conducted to verify the robustness of the proposed strategy.
Adolescence is a period marked by highest vulnerability to the onset of depression, with profound implications for adult health. Neuroimaging studies have revealed considerable atrophy in brain structure in these patients with depression. Of particular importance are regions responsible for cognitive control, reward, and self-referential processing. However, the causal structural networks underpinning brain region atrophies in adolescents with depression remain unclear.
Objectives
This study aimed to investigate the temporal course and causal relationships of gray matter atrophy within the brains of adolescents with depression.
Methods
We analyzed T1-weighted structural images using voxel-based morphometry in first-episode adolescent patients with depression (n=80, 22 males; age = 15.57±1.78) and age, gender matched healthy controls (n=82, 25 males; age = 16.11±2.76) to identify the disease stage-specific gray matter abnormalities. Then, with granger causality analysis, we arranged the patients’ illness duration chronologically to construct the causal structural covariance networks that investigated the causal relationships of those atypical structures.
Results
Compared to controls, smaller volumes in ventral medial prefrontal cortex (vmPFC), dorsal anterior cingulate cortex (dACC), middle cingulate cortex (MCC) and insula areas were identified in patients with less than 1 year illness duration, and further progressed to the subgenual ACC, regions of default, frontoparietal networks in longer duration. Causal network results revealed that dACC, vmPFC, MCC and insula were prominent nodes projecting exerted positive causal effects to regions of the default mode and frontoparietal networks. The dACC, vmPFC and insula also had positive projections to the reward network, which included mainly the thalamus, caudate and putamen, while MCC also exerted a positive causal effect on the insula and thalamus.
Conclusions
These findings revealed the progression of structural atrophy in adolescent patients with depression and demonstrated the causal relationships between regions involving cognitive control, reward and self-referential processes.
White matter hyperintensities (WMH) is common among the elderly. WMH are associated with accelerated cognitive dysfunction and increased risk for Alzheimer`s disease (AD). Although WMHs play a key role in lowering the threshold for the clinical expression of dementia in AD-related pathology, the clinical significance of their location is not fully understood.
Objectives
The aim of this study was twofold: 1) To investigate the quantitative association between WMH and cognitive function in AD; 2) To investigate whether there is any difference in the association between subclassified WMH and cognitive function in AD.
Methods
A total of 171 patients with AD underwent clinical evaluations including volumetric brain MRI study and neuropsychological tests using the CERAD-K neuropsychological assessment battery. WMH volume was calculated using automated quantification method with SPM and MATLAB image processing software. According to the distance from the lateral ventricular surface, WMH within 3 mm, WMH within 3-13 mm, and WMH over 13 mm were classified as juxtaventricular WMH (JVWMH), periventricular WMH (PVWMH) and deep WMH (DWMH), respectively. WMH volume data was logarithmically transformed because it was right-skewed.
Results
WMH volume in AD was 20.7 ± 18.2 ml. Total WMH volume was associated with poor performance in categorical verbal fluency test (p = 0.008) and word list memory test (p = 0.023). JVWMH volume was associated with poor performances on categorical verbal fluency test (p = 0.013) and forward digit span test (p = 0.037). PVWMH volume was associated with poor performances on categorical verbal fluency test (p = 0.011) and word list memory test (p = 0.021), whereas DWMH volume showed no association with cognitive tests. Total WMH and PVWMH volume were also related to Clinical Dementia Rating scale sum of boxes score (p=0.022).
Image:
Conclusions
Greater JVWMH and PVWMH are related with concurrent impairments in semantic memory and frontal function independent of the hippocampal volume. However, DWMH volume is not associated with any cognitive function. Only PVWMH among subclassified WMH are related to the severity of AD.
This study investigates the effects of transcranial direct current stimulation (tDCS) on food craving improvement and changes in brain function associated with craving in overweight and obese subjects.
Objectives
Food craving disregards the homeostatic mechanisms related to appetite and nullifies the rewarding effects of food, directly contributing to body weight and eventually leading to obesity. In this study, we aim to explore the effects of transcranial direct current stimulation (tDCS) on food craving improvement and changes in brain function associated with craving by conducting a total of 10 sessions of tDCS over a period of 2 weeks on overweight and obese subjects.
Methods
A total of 86 patients who were overweight or obese (BMI ≥ 23 kg/m2) during the study period were included. The tDCS montage involved placing the anode over the left and the cathode over the right DLPFC. Weight, BMI, neuropsychological variables, and food craving-related variables were assessed. We measured absolute and relative EEG power in 19 channels and analyzed QEEG according to the following frequency ranges: delta (1–4 Hz), theta (4–8 Hz), alpha (8–12 Hz), beta (12–25 Hz), high beta (25–30 Hz), and gamma (30–80 Hz).
Results
After the application of tDCS, there was no significant reduction observed in weight and BMI. However, all measures related to food and eating showed a decrease in the intensity of cravings, and there was also a significant reduction in depression, anxiety, and perceived stress. In quantitative EEG analysis, an increase in theta waves was observed in the left frontal area (F7 and F3), an increase in alpha waves in the right parietal area (P4), and a decrease in beta waves in the frontal area (FP2) and occipital area (O1).
Conclusions
This study investigated the effects of tDCS on food craving in overweight and obese individuals, and it was found that there were improvements in psychological factors such as depression and anxiety. Additionally, using quantitative EEG, neurophysiological changes were observed, including an increase in theta waves and a decrease in beta waves.
Syphilis remains a serious public health problem in mainland China that requires attention, modelling to describe and predict its prevalence patterns can help the government to develop more scientific interventions. The seasonal autoregressive integrated moving average (SARIMA) model, long short-term memory network (LSTM) model, hybrid SARIMA-LSTM model, and hybrid SARIMA-nonlinear auto-regressive models with exogenous inputs (SARIMA-NARX) model were used to simulate the time series data of the syphilis incidence from January 2004 to November 2023 respectively. Compared to the SARIMA, LSTM, and SARIMA-LSTM models, the median absolute deviation (MAD) value of the SARIMA-NARX model decreases by 352.69%, 4.98%, and 3.73%, respectively. The mean absolute percentage error (MAPE) value decreases by 73.7%, 23.46%, and 13.06%, respectively. The root mean square error (RMSE) value decreases by 68.02%, 26.68%, and 23.78%, respectively. The mean absolute error (MAE) value decreases by 70.90%, 23.00%, and 21.80%, respectively. The hybrid SARIMA-NARX and SARIMA-LSTM methods predict syphilis cases more accurately than the basic SARIMA and LSTM methods, so that can be used for governments to develop long-term syphilis prevention and control programs. In addition, the predicted cases still maintain a fairly high level of incidence, so there is an urgent need to develop more comprehensive prevention strategies.
Background: The formation of pial-pial collateral network aneurysms due to carotid occlusion is a rare neurological phenomenon. This case details a 69-year-old male who developed a pial-pial collateral network aneurysm secondary to left internal carotid artery occlusion, leading to intracranial hemorrhage. Methods: The patient presented with altered consciousness due to left temporal intracerebral hemorrhage, subdural hematoma, and intraventricular hemorrhage. Cerebral angiography revealed an occluded left internal carotid artery, with superficial temporal artery (STA) and superior orbital artery anastomosis, and extensive pial-pial collaterals from the posterior temporal artery. A 4 mm aneurysm arising from this collateral network was identified. Surgical intervention involved a left temporal craniectomy and excision of the aneurysm, prioritizing the preservation of the STA. N.B., Informed patient consent was obtained in this study. Results: Successful aneurysm removal and preservation of collateral pathways were confirmed by postoperative imaging. The patient exhibited rapid neurological improvement; by postoperative day (POD) one, the patient showed limited response to stimuli. He was extubated by POD4 and discharged on POD27, where he conversed well, was independently ambulatory, and needed minimal to no assistance in activities of daily living. Conclusions: This case highlights the need for careful preoperative planning and intraoperative precision, especially in preserving vital collateral vascular pathways.
Background: The diagnosis of leptomeningeal metastatic disease has major prognostic implications. We report 13 patients with a radiologically distinct, focal, enhancing leptomeningeal lesion on brain MRI mimicking leptomeningeal metastatic disease. Methods: These patients were assessed at University Health Network between January 2001 and December 2023. Results: Median age was 68 years and 10 patients were women. All patients had brain MRI including contrast-enhanced T2-weighted FLAIR and T1-weighted spin echo sequences. MRI in all patients showed a focal enhancing lesion along the leptomeningeal surface of the brain. The MRI exams were reported as possible metastatic disease for the majority (9/13) of patients. Each lesion was curvilinear rather than sheet-like, and some consisted of multiple connected/branching curvilinear structures with the appearance of abnormal vessels. Some lesions had visible connection with a nearby cortical vein. The lesions were distinct from normal blood vessels. Follow-up contrast-enhanced brain MRI for 8/13 patients at a median of 3.9 years showed all lesions were unchanged over time. Conclusions: We describe a distinct kind of focal, enhancing leptomeningeal lesion on brain MRI that mimics metastatic disease. These lesions are likely a type of low-flow vascular anomaly. Their curvilinear/branching shape and intense enhancement particularly on T2-weighted FLAIR images distinguishes these lesions from tumor.
Background: Prolonged length of stay (LOS) after elective spine surgery increases patients’ risk for in-hospital complications and contributes significantly to healthcare costs. Here we explored the role of pain control and other perioperative factors on LOS. Methods: Consecutive adult patients undergoing elective spine surgery were enrolled. The primary outcome was in-hospital LOS following surgery. The primary independent variable was poor pain control on postoperative day 1 (POD1). Univariable analyses followed by multivariable regression analysis were used to investigate the relationship between poor pain control and LOS. Results: 1305 patients were enrolled. Mean LOS was 4.38 days. Incidence of poor pain control was 56.9%. Multivariable analysis revealed poor POD1 pain control was significantly associated with increased LOS (p=0.03), after adjusting for other significant predictors of increased LOS including perioperative hemodynamic instability (p=0.001), perioperative blood transfusion (p=0.000), delirium (p=0.000), POD1 morphine equivalent dose (p=0.000), urinary tract infection (p=0.000), urinary retention (p=0.003), surgical site infection (p=0.000), wound complication (p=0.000), neurologic deterioration (p=0.000), surgical levels (p=0.016), operative time (p=0.007), ASA score (p=0.000), preoperative disability score (p=0.001). Conclusions: Poor pain control on POD1 was an independent predictor of increased LOS after elective spine surgery, highlighting the importance of a proactive approach to addressing pain in the immediate postoperative period.
Sometimes patients and clinicians don’t agree and there is conflict. Many people prefer to avoid conflict, however working through it allows us to discuss our differences of opinion, explore the options, and come up with an agreement that we all can live with. Good communication skills can help shift the focus from “Who’s right?” to “What’s our shared interest?” This roadmap is different as it is about how you find your path amidst conflict. Start by noticing there is a disagreement. Prepare yourself by pausing, being curious, and assuming positive intent. Invite the other person’s perspective and listen to their story, emotion, and what it means to their sense of self. Identify what is at the root of the conflict and if possible, articulate it as a shared interest. Brainstorm to address the shared interest, and look for options that address everyone’s goals. Remember that conflicts occur because people care deeply, which means that resolving the conflict will take time and effort. Even in instances where it is not possible to agree, skillful communication can allow for graceful disagreement.
Conflict with our colleagues is stressful and evokes strong emotion, yet handled well can improve outcomes and relationships and enhance collaboration. There are issues of hierarchy, power, and respect. Similar to dealing with conflict with patients is the need to establish a safe space, practice deep listening, and earn trust. Being open to exploring the breadth of the problem, both parties perspectives, your role in the conflict, how you feel about events, and what it means to you will help you approach the situation with a more open mind. Keeping a focus on improving the situation and relationship rather than solely on being right will help maintain calm. The roadmap for conflict with colleagues includes noticing when conflict is bubbling up, preparing your approach instead of jumping in reactively, starting softly to avoid provoking defensiveness, inviting the other person’s perspective before you share yours, using neutral language to reframe emotionally charged issues, acknowledging the emotion of the situation (rather than handling your colleague’s emotions directly), and finding a path forward that addresses both parties’ concerns, creating new options where needed.
To hone your skills, one needs to observe what “good” looks like, practice, and receive feedback. We recommend setting a communication skills goal before the encounter, and then debriefing how it went, celebrating what you did well, and considering what to do differently next time, as well as what you learned in the process. Practicing skills in conversation roadmaps is incomplete without building of our internal capacities, like curiosity and emotional awareness, which help us foster more authentic connection. Learning new skills is not linear. Be kind to yourself when you’re having a bad day or feeling burnt out. Better communication skills can help they leads to more engaged clinical encounters which provide positive feedback making patient care more rewarding. Also, the roadmaps in this book are a kind of scaffold for learning, intended to provide support until you get your foundation settled. After a while, you may no longer need them. True expertise requires building both skills and capacities, practicing regularly, and caring for oneself in the process.