Machine learning model for early prediction of acute respiratory failure in acute pancreatitis: Multicenter validation.

An exploratory study of circulating cell-free mRNAs across colorectal cancer stages.

Most research on automatic speech analysis (ASA) has focused on acoustic features, while the potential of linguistic markers remains underexplored, particularly in clinically diagnosed, non-English-speaking populations. This study evaluated the integration of acoustic and linguistic markers for detecting depression in a Spanish-speaking clinical sample. The sample comprised 151 participants: 80 patients with major depressive disorder (MDD) or persistent depressive disorder (PDD) recruited from the Psychiatry Department of Vall d'Hebron University Hospital and 71 healthy controls. Participants answered 11 open-ended questions related to depressive symptoms and well-being via a web-based platform. Linguistic and acoustic variables spanning four categories, namely, prosodic, cepstral, spectral, and Teager Energy Operator (TEO)-based features, were extracted. Group comparisons and logistic regressions were performed to assess the predictive value of acoustic and linguistic features. Machine learning models were used to compare the performance of acoustic, linguistic, and ensemble classification models, combining both feature sets. TEO-based and cepstral features showed the strongest predictive power. Greater use of verbs, reduced use of nouns and past-tense verbs, smaller vocabulary size, and increased use of shorter words and sentences remained strong predictors of depression after adjusting for covariates. The linguistic model outperformed the acoustic model (AUC=0.86 vs. = 0.79), while the ensemble modelachieved comparable overall performance (AUC=0.86), with slightly improved accuracy (0.84) and specificity (0.93). Integrating linguistic features into automated speech analysis shows promise for depression detection. With further validation and refinement, brief speech-based assessments could support early depression detection in primary care.

Adaptive fusion of EEG and NIRS with explainable AI reveals neurophysiological markers of cognitive flexibility.

GOLD BioAge and depression: Associations with mortality among depressed NHANES participants (2005-2018).

A longitudinal cohort study of damp and mouldy housing and children's respiratory health in Bradford, UK.

Depressive symptoms are common among adults with diabetes and are associated with adverse clinical outcomes, including mortality. Evidence from general populations suggests that physical activity (PA) and diet quality (DQ) may have a joint relationship with mental health and survival; however, evidence focusing specifically on adults with diabetes remains comparatively sparse. We analyzed data from 3451U.S. adults with diabetes in the NHANES 2007-2018 dataset. Depressive symptoms were assessed at the baseline examination using the Patient Health Questionnaire-9 (PHQ-9 score≥10), and all-cause mortality was ascertained through linkage to the National Center for Health Statistics linked mortality files up to December 31, 2019. PA (MET-min/week) and DQ (Healthy Eating Index-2015 [HEI-2015]) were examined using survey-weighted logistic regression for prevalent depressive symptoms and survey-weighted Cox proportional hazards models for subsequent mortality, with restricted cubic splines to assess dose-response relationships. Multiplicative and additive interactions between PA and DQ were evaluated. Additionally, complementary machine learning analyses were conducted to evaluate predictive performance and feature contributions. Higher PA and better DQ were generally associated with lower odds of depressive symptoms and lower hazards of all-cause mortality. A combined favorable PA and DQ profile was also associated with more favorable outcomes. PA showed a nonlinear inverse association with depressive symptoms, with lower predicted probabilities around 2000-3000 MET-min/week, whereas HEI-2015 did not demonstrate a nonlinear association. These findings highlight the potential importance of integrated lifestyle behaviors in relation to mental health and survival among adults with diabetes.

Linking bone and brain: Dysregulated bone metabolism exacerbates cognitive impairment in bipolar disorder.

Prediction of early mortality in acute pancreatitis using arterial base excess: an international multicenter cohort study.

Racial trauma is a growing mental health concern among ethnoracially minoritized college students. Limited research has examined campus-level promotive factors that may mitigate suicidal ideation (SI) in this population. This study explored whether student perceptions of antiracist campus climate and campus involvement in cultural/racial student organizations moderated the relationship between racial trauma symptoms and SI. We conducted a cross-sectional analysis of 23,414 ethnoracially minoritized students (ages 18-26) from 135 U.S. colleges using data from the 2022-2023 Healthy Minds Study. Multilevel logistic regression models assessed associations between racial trauma symptoms, campus-level promotive factors, and past-year SI, controlling for sociodemographic and institutional variables. Higher racial trauma symptoms scores were significantly associated with greater odds of SI (OR=1.11, 95% CI=1.09-1.12, p<0.001). Students who perceived their campuses as actively combating racism (OR=0.71, p<0.001) or were involved in cultural/racial organizations (OR=0.79, p<0.01) were significantly less likely to report SI. However, these factors did not significantly moderate racial trauma and SI. Gender diverse students as well as students in Southern and East South-Central regions were noted to face higher SI risk. Although antiracism climate and campus involvement did not buffer the psychological toll of racial trauma, they were associated with lower SI risk. Institutions should prioritize multilevel antiracism mental health promotion strategies to support these students.

Despite the megatrend of immigration and subsequent studies on immigrant health outcomes, little is known about how parental immigration status specifically affects offspring mental health service utilization. This register study investigates how parental immigration status relates to offspring mental health service utilization for anxiety, depression, and comorbid anxiety and depression. Using Finnish national registers (1992-2006 birth cohort), we analyzed parental immigration status and their association with mental health service use for 33,137 cases matched with 138,957 controls based on age and biological sex. We used multinomial logistic regression to calculate adjusted odds ratios (aORs), controlling for parental age, parity, parental psychopathology, socioeconomic status, and marital status. Children with two immigrant parents had reduced likelihood of service use for all outcomes: comorbid anxiety and depression (aOR 0.4, 95% CI 0.3-0.6, p<0.001), depression only (aOR 0.5, 95% CI 0.4-0.6, p<0.001), and anxiety only (aOR 0.8, 95% CI 0.7-0.9, p=0.001). Those with immigrant fathers and Finnish mothers showed increased likelihood across all outcomes: comorbid anxiety and depression (aOR 1.6, 95% CI 1.4-1.8, p<0.001), anxiety only (aOR 1.4, 95% CI 1.3-1.6, p<0.001), and depression only (aOR 1.4, 95% CI 1.2-1.6, p<0.001). Maternal immigration <1year before childbirth lowered service use of comorbid conditions. Children with both parents from low HDI countries and with mothers from Sub-Saharan Africa exhibited significantly lower service utilization. The significant differences in mental health service utilization among children of immigrant parents suggest that cultural factors, healthcare navigation skills, and migration-related stressors may influence service-seeking behaviors.

Adults with unexplained neurologic presentations often undergo extensive evaluations without timely diagnosis. Evidence supporting the clinical utility of rapid whole-genome sequencing (rWGS) in hospitalized adult populations remains limited. We evaluated the diagnostic yield of rWGS in adults hospitalized for unexplained neurologic manifestations and assessed clinical predictors of a phenotype-concordant genetic diagnosis. We performed a retrospective cohort analysis of adult inpatients (≥18 years) undergoing rWGS as part of a structured inpatient clinical genomics implementation at Mayo Clinic between June 2022 and September 2025. Testing was performed after primary team consultation and subsequent assessment by a clinical geneticist. We prespecified a neurologic cohort restricted to patients admitted to the neurology inpatient service in whom presenting neurologic phenotypes were the primary indication for hospitalization and genomics consultation. Patients with non-neurologic primary indications were excluded from this study. The primary outcome was a phenotype-concordant genetic diagnosis on rWGS determined by genotype-phenotype assessment. Analytic objectives included identification of clinical predictors of a phenotype-concordant genetic diagnosis, and a secondary outcome was rWGS-attributable changes in clinical management. Patients with and without phenotype-concordant diagnoses were compared using univariable logistic regression for categorical candidate predictors (odds ratios [ORs] with 95% CIs) and the t test for age. Among 96 adults who completed rWGS, 57 (59.4%) met criteria for the neurologic cohort (mean age 53.0 ± 18.0 years; 35.1% female). Thirteen of 57 (22.8%) received a phenotype-concordant genetic diagnosis involving IFIH1, CNBP, NOTCH1, C9orf72, FGF14, HUWE1, NLRP12, CCM2, PTPN11, FLNA, HEXA, PRNP, and ATXN8OS. Factors associated with a phenotype-concordant diagnosis included a family history of similar neurologic symptoms in first-degree or second-degree relatives (OR 7.4; 95% CI 1.9-31.5), multisystem involvement (OR 6.9; 95% CI 1.6-29.8), refractory psychiatric symptoms (OR 6.1; 95% CI 1.1-35.7), and unexplained ataxia (OR 4.0; 95% CI 1.1-15.1). rWGS directly altered clinical management in 2 cases, including initiation of immunotherapy for an NLRP12-associated autoinflammatory disorder and enrollment in a gene-therapy trial for adult-onset Tay-Sachs disease. In this tertiary-care inpatient cohort, rWGS identified a phenotype-concordant genetic diagnosis in nearly one-quarter of adults. Limitations include single-center design and preselection through specialized consultation, which may limit generalizability.

Recent randomized trials reported no overall functional benefit of endovascular treatment (EVT) for distal medium-vessel occlusion (DMVO) and did not identify consistent effect modifiers to guide patient selection. Consequently, the role of EVT-particularly for M2 occlusions-remains controversial. We investigated whether baseline clinical severity modifies the association between successful recanalization and 90-day outcome in patients with M2 occlusion. Multicenter retrospective cohort study at 2 tertiary stroke centers including consecutive adults with acute ischemic stroke due to M2 occlusion (January 2015-January 2023) triaged by multimodal CT and treated with EVT. The primary end point was functional independence (modified Rankin Scale [mRS] ≤ 2) at 90 days. Secondary end points included symptomatic intracerebral hemorrhage (sICH), mRS 0-1, and penumbra salvage volume (PSV). The primary analysis used multivariable logistic regression with baseline National Institutes of Health Stroke Scale (NIHSS) modeled linearly and an NIHSS×recanalization (modified Thrombolysis in Cerebral Infarction [mTICI] ≥2b) interaction term. Johnson-Neyman probing and inverse probability weighting (IPW) were applied; a supplementary restricted cubic spline analysis was performed to explore potential nonlinearity. Among 147 patients, 85 (58%) achieved successful recanalization. The mean age was 74 years (SD 13), and 47% were female. Higher baseline NIHSS (adjusted odds ratio [aOR] 0.83 per point, 95% CI 0.73-0.94) and older age (aOR 0.96 per year, 95% CI 0.94-0.99) were associated with lower odds of functional independence. NIHSS significantly modified the association between recanalization and outcome (interaction p = 0.03). The magnitude of the association between successful recanalization and functional independence was larger at higher NIHSS. Model-based estimates suggested a descriptive crossover around NIHSS 10, whereas statistical evidence of benefit emerged only at higher NIHSS values. Successful recanalization was associated with greater PSV (+33 mL, p = 0.01). In the PSV interaction model, onset-to-imaging time differed by recanalization status (p < 0.01): time was positively associated with PSV in the mTICI ≤2a group, but near zero in mTICI ≥2b. IPW analyses were concordant. sICH occurred in 8.2% vs 4.8% (p = 0.42). In M2 occlusions, the magnitude of the association between successful recanalization and functional independence was larger at higher NIHSS and not reliably demonstrable at lower NIHSS. These findings support a severity-informed, individualized EVT approach while remaining hypothesis-generating rather than prescriptive for specific NIHSS thresholds. Major limitations include the retrospective observational design and potential residual confounding.

The cost and complexity of phase 2 randomized-controlled trials (RCTs) hinder further development of promising treatment candidates for Alzheimer disease (AD). The Simon Two-Stage futility trial design, originally developed for oncology, offers a streamlined approach to evaluate potential disease-modifying therapies by comparing single-arm outcomes with historical controls, but is predicated on identifying outcome measures that reliably worsen with the natural history of the disease, with minimal risk of improvement. We sought to determine the feasibility of such futility trials in AD-associated dementia and mild cognitive impairment (MCI) using a large prospective cohort. We analyzed longitudinal data from the Alzheimer's Disease Neuroimaging Initiative (ADNI). Cognitive decline was assessed using AD Assessment Scale-Cognitive Subscale (ADAS-Cog 11 and ADAS-Cog 13), Clinical Dementia Rating-Sum of Boxes (CDR-SB), and Mini-Mental State Examination (MMSE) at 6, 12, and 24 months using different thresholds for worsening vs improvement. Binary logistic regression models examined baseline factors associated with cognitive worsening using different thresholds of worsening for each outcome of interest to assess what additional selection criteria may be needed for futility trials in AD-associated dementia vs MCI. Sample size estimates were derived based on expected rates of decline. Among 2,665 participants (mean age 73.4 years [SD: 7.5], 1,260 [47.3%] female, 424 with AD-associated dementia), the CDR-SB exhibited the largest percentage of decline in AD-associated dementia and MCI, with 60.6% of patients with AD-associated dementia showing worsening when using a threshold of ≥1.0 points at 12 months vs 6.2% showing improvement. ADAS-Cog 11 and 13 showed similar decline patterns; for example, 41.7% with AD-associated dementia worsened by ≥ 5 points at 12 months on ADAS-Cog 13, whereas 5.8% improved. MMSE exhibited lower sensitivity; 25.8% with AD-associated dementia worsened by ≥ 5 points at 12 months, whereas 2.9% improved. Shorter trials (6-12 months) with 35-62 participants seemed feasible in AD-associated dementia, whereas MCI trials seemed to require 24 months and specific entry criteria based on age, apolipoprotein E ε4 status, and baseline CDR-SB performance. Futility trials seem feasible in AD-associated dementia, offering a faster, cost-effective alternative to traditional phase 2 RCTs. CDR-SB seems to be the optimal primary outcome. Further validation in clinical trial data sets is warranted.

Dropout from the pentavalent vaccine series among children aged 12-23months in the Central African Republic: prevalence, associated factors, and caregiver-reported barriers.

Associations between childhood adversity and human papillomavirus vaccination in Australian women: a cross-sectional study.

Recent enough to matter: Perceived temporal proximity, anxiety, and COVID-19 vaccine intent.

Pregnant women's knowledge, perceptions, and intention to receive a future group B Streptococcus (GBS) vaccine: a cross-sectional study.

Lipid peroxidation marker malondialdehyde is an independent determinant of hepatitis B vaccine response in hemodialysis patients.

Primary spinal osteosarcoma is a rare, morbid malignancy, frequently involving critical neurovascular structures and causing neurological compromise. Evidence guiding management is limited, and the benefit of surgery and perioperative chemotherapy is largely extrapolated from extremity disease. This study evaluates overall survival (OS) among surgically treated spinal osteosarcoma patients, examines the influence of chemotherapy and treatment sequence, and identifies predictors of chemotherapy administration. Using the National Cancer Database (2004-2023), we identified patients with histologically confirmed spinal osteosarcoma who underwent surgery. Baseline characteristics were compared between surgery-only and surgery and chemotherapy cohorts. OS was assessed using Kaplan-Meier analysis, with interaction testing for grade and treatment effects. Multivariable Cox models were performed. A logistic regression model evaluated predictors of chemotherapy utilization. A total of 899 surgically treated patients were analyzed; 685 (76%) received chemotherapy. Before matching, the combination of surgery and chemotherapy was associated with superior 30-, 90-day, and 1-year survival (all P < .001). Kaplan-Meier curves demonstrated improved OS at both 1 and 5 years for surgery and chemotherapy, with the greatest impact observed in high-grade disease. In multivariable analysis, surgery and chemotherapy in low-grade osteosarcomas was associated with lower mortality (hazard ratio 0.51, P = .025 [0.28, 0.92]). No survival difference was observed between neoadjuvant, adjuvant, or combined sequencing. Among patients undergoing resection for spinal osteosarcoma, perioperative chemotherapy was associated with improved early and unadjusted OS, with the greatest impact observed in high-grade tumors. However, this survival advantage was attenuated in adjusted analysis. These findings suggest that although chemotherapy remains critical in high-grade spinal osteosarcoma, its role in low-grade disease where toxicity may outweigh the benefit warrants further investigation.