Artificial intelligence-enhanced electrocardiogram analysis for identifying cardiac autonomic neuropathy in patients with diabetes.

AIM: To develop and employ machine learning (ML) algorithms to analyse electrocardiograms (ECGs) for the diagnosis of cardiac autonomic neuropathy (CAN). MATERIALS AND METHODS: We used motif and discord extraction techniques, alongside long short-term memory networks, to analyse 12-lead, 10-s ECG tracings to detect CAN in patients with diabetes. The performance of these methods with the support vector machine classification model was evaluated using 10-fold cross validation with the following metrics: accuracy, precision, recall, F1 score, and area under the receiver-operating characteristic curve (AUC). RESULTS: Among 205 patients (mean age 54 ± 17 years, 54% female), 100 were diagnosed with CAN, including 38 with definite or severe CAN (dsCAN) and 62 with early CAN (eCAN). The best model performance for dsCAN classification was achieved using both motifs and discords, with an accuracy of 0.92, an F1 score of 0.92, a recall at 0.94, a precision of 0.91, and an excellent AUC of 0.93 (95% confidence interval [CI] 0.91-0.94). For the detection of any stage of CAN, the approach combining motifs and discords yielded the best results, with an accuracy of 0.65, F1 score of 0.68, a recall of 0.75, a precision of 0.68, and an AUC of 0.68 (95% CI 0.54-0.81). CONCLUSION: Our study highlights the potential of using ML techniques, particularly motifs and discords, to effectively detect dsCAN in patients with diabetes. This approach could be applied in large-scale screening of CAN, particularly to identify definite/severe CAN where cardiovascular risk factor modification may be initiated.

Barriers, Facilitators, and Strategies to Improve Participation of a Couple-Based Intervention to Address Women's Antiretroviral Therapy Adherence in KwaZulu-Natal, South Africa.

BACKGROUND: Couple-based interventions (CBIs), despite strong efficacy in improving numerous HIV risk behaviors, are not widely available and have not been tested to improve women's antiretroviral therapy (ART) adherence. We examined barriers and facilitators to participation in a CBI based on cognitive behavioral couple therapy for women's ART adherence in KwaZulu-Natal, South Africa. METHODS: Semi-structured interviews were conducted with women with HIV (n = 15) and men of mixed HIV status (n = 15). Thematic analyses were guided by the Consolidated Framework for Implementation Research. RESULTS: Facilitators mostly related to the couple's relationship, including having an existing healthy relationship, men's desire to support their partners, and a potential opportunity for men's HIV disclosure. Barriers included a lack of understanding of how a CBI approach would be useful for women's ART adherence, sole focus on women if male partners were also living with HIV, and men's lack of prior HIV status disclosure to female partners. CONCLUSION: Findings indicate that relationship context and the male partner's HIV status need to be addressed during recruitment, enrolment, and during the intervention to promote uptake.

Suicidality risk in children and adolescents with externalizing disorders: symptoms profiles at high risk and the moderating role of dysregulated family relationships.

Children and adolescents with externalizing disorders are at risk for suicidal ideation or behavior. Factors that put them at risk could be symptoms related or facilitated by their environment. We evaluated the links of symptoms profiles with suicidality, and the effects of family relationship characteristics on these links. Latent profile analysis was used to subgroup participants referred for ADHD assessment (n = 1249, aged 6-17) based on their externalizing and internalizing symptoms. Self- and parent-reported child suicidal ideation (S-SI, P-SI), and parent-reported self-harm behavior (P-SHB) were compared across profiles. The moderating effects of parent-reported marital conflict and parenting practices were examined. A four-profile model showed optimal fit. Participants of the Low Symptoms profile followed by the Inattentive-Hyperactive/Impulsive profile showed lower P-SI compared to those of the Irritable-Defiant and the Conduct Problems profiles. Low Symptoms participants also reported lower S-SI compared to those of the Inattentive-Hyperactive/Impulsive and the Irritable-Defiant profiles. Participants of the Irritable-Defiant and the Conduct Problems profiles had higher P-SHB compared to the Low Symptoms and the Inattentive-Hyperactive/Impulsive participants. Dysregulated marital conflict practices were associated with greater increase in P-SI in all profiles compared to the Low Symptoms profile. Aggressive marital conflict practices were associated with increased P-SHB in the Conduct Problems profile compared to the Inattentive-Hyperactive/Impulsive profile. Children and adolescents with irritability and defiance symptoms with or without conduct problems show higher risk for suicidal ideation and behavior compared to those with ADHD symptoms alone. Dysregulated and aggressive marital conflict practices might pose additional suicidality risk in children and adolescents with disruptive behavior.

The Days Add Up: Daily Marital Discord and Depressive Reactivity Linked to Past-Month Depressed Mood and Marital Risk across 10 Years.

Marital discord fuels depression, according to decades of research. Most prior studies in this area have focused on macro-longitudinal change in depression over the course of years, and on global ratings of marital satisfaction. Less work has examined fluctuations in depressed mood and marital discord in daily life, and none has investigated associations of short-term patterns with longer-term depressed mood and marital outcomes. Using data from participants in the Midlife in the U.S. (MIDUS) project, the current study examined daily associations between marital discord and depressed mood, as well as their links to concurrent and prospective patterns of past-month depressed mood and marital risk. Results showed that, on average, depressed mood rose on days when individuals had an argument or tension with their spouse (i.e., marital discord). More frequent daily marital discord was also associated with greater past-month depressed mood and marital risk, above and beyond prior levels. Those with larger depressive mood responses to discord in daily life (i.e., greater reactivity) exhibited higher concurrent past-month depressed mood and greater 10-year increases in depressed mood. As the first study to link daily marital patterns to concurrent and prospective changes in depressed mood and marital outcomes, this investigation uncovered two novel processes-daily marital discord and depressive reactivity-as important for understanding long-term patterns of marital risk and depression.

Estimation of the Influence of a Noisy Environment on the Binary Decision Strategy in a Quantum Illumination Radar.

A quantum illumination radar uses quantum entanglement to enhance photodetection sensitivity. The entanglement is quickly destroyed by the decoherence in an environment, although the sensitivity enhancement could survive thanks to quantum correlations beyond the entanglement. These quantum correlations are quantified by the quantum discord. Here, we use a toy model with an amplitude damping channel and Lloyd's binary decision strategy to highlight the possible role of these correlations from the perspective of a quantum radar.

Analysis of Quantum Correlations Obtained Using Local Optimal Universal Asymmetric Cloners.

We apply the local optimal universal asymmetric cloning machine on an initially pure entangled state of two qubits. As output, we obtain two final states which present quantum correlations. We analyze three types of quantum correlations among the final states, namely, concurrence, quantum discord, and consonance. A detailed comparison between concurrence, quantum discord, and consonance is made, and we find that consonance is greater than quantum discord, which is in turn greater than concurrence.

A phylogenomic approach resolves the backbone of Prunus (Rosaceae) and identifies signals of hybridization and allopolyploidy.

The genus Prunus, which contains 250-400 species, has ample genomic resources for the economically important taxa in the group including cherries, peaches, and almonds. However, the backbone of Prunus, specifically the position of the racemose group relative to the solitary and corymbose groups, remains phylogenetically uncertain. Surprisingly, phylogenomic analyses to resolve relationships in the genus are lacking. Here, we assemble transcriptomes from 17 Prunus species representing four subgenera, and use existing transcriptome assemblies, to resolve key relationships in the genus using a phylogenomic approach. From the transcriptomes, we constructed 21-taxon datasets of putatively single-copy nuclear genes with 591 and 379 genes, depending on taxon-occupancy filtering. Plastome sequences were obtained or assembled for all species present in the nuclear data set. The backbone of Prunus was resolved consistently in the nuclear and chloroplast phylogenies, but we found substantial cytonuclear discord within subgenera. Our nuclear phylogeny recovered a monophyletic racemose group, contrasting with previous studies finding paraphyly that suggests repeated allopolyploidy early in the evolutionary history of the genus. However, we detected multiple species with histories consistent with hybridization and allopolyploidy, including a deep hybridization event involving subgenus Amygdalus and the Armeniaca clade in subgenus Prunus. Analyses of gene tree conflict revealed substantial discord at several nodes, including the crown node of the racemose group. Alternative gene tree topologies that conflicted with the species tree were consistent with a paraphyletic racemose group, highlighting the complex reticulated evolutionary history of this group.

Associations Between Marital Discord and Depressive Symptoms: A Cross-Cultural Analysis.

The objectives of this study were to investigate actor and partner effects of the association between marital discord and depressive symptoms in a sample of 4,779 couples from 11 European countries that were divided into three groups (i.e., Northern, Central, Southern Europe), and evaluate the potential gender and cross-cultural invariance of this association. Actor-partner interdependence models were used to analyze the cross-sectional associations between self-reported perceived marital conflict and depressive symptoms. Marital conflict was significantly and positively associated with self-reported depressive symptoms for husbands and wives (actor effects), as well as with partner-reported depressive symptoms (partner effects). Pooling across cultural groups, no significant difference in the magnitude of actor or partner effects based on gender was found. The magnitude of the actor effects varied across cultural groupings only for women: a significantly weaker association existed for women residing in Northern Europe relative to women in Central or Southern Europe. These results suggest that marital discord is a reliable correlate of depressive symptoms for European couples and that the magnitude of the positive association varies by culture for women. Should these results be replicated longitudinally, couple-based interventions may be indicated to reduce marital discord and prevent and treat depression in Europe.

Los objetivos de este estudio fueron investigar los efectos en el actor y la pareja de la asociación entre el desacuerdo conyugal y los síntomas depresivos en una muestra de 4779 parejas de 11 países europeos que se dividieron en tres grupos (p. ej.: Europa septentrional, Europa Central y Europa meridional) y evaluar la posible invariancia intercultural y de género de esta asociación. Se utilizaron los modelos de interdependencia actor-pareja para analizar las asociaciones transversales entre el conflicto conyugal percibido y los síntomas depresivos autoinformados. El conflicto conyugal estuvo asociado considerable y positivamente con síntomas depresivos autoinformados para los esposos y las esposas (efectos en el actor), así como con síntomas depresivos informados por las parejas (efectos en la pareja). Al combinar los grupos culturales, no se encontró una diferencia significativa en la magnitud de los efectos en el actor o en la pareja sobre la base del género. La magnitud de los efectos en el actor varió entre grupos culturales solo en el caso de las mujeres: existió una asociación considerablemente más débil para las mujeres que viven en Europa septentrional respecto de las mujeres de Europa Central o Europa meridional. Estos resultados sugieren que los desacuerdos conyugales se correlacionan de manera fiable con los síntomas depresivos en las parejas europeas, y que la magnitud de la asociación positiva varía según la cultura en el caso de las mujeres. Si estos resultados se repitieran longitudinalmente, podrían indicarse intervenciones basadas en la pareja para disminuir el desacuerdo conyugal y prevenir y tratar la depresión en Europa.

Mutual Information and Quantum Discord in Quantum State Discrimination with a Fixed Rate of Inconclusive Outcomes.

We studied the mutual information and quantum discord that Alice and Bob share when Bob implements a discrimination with a fixed rate of inconclusive outcomes (FRIO) onto two pure non-orthogonal quantum states, generated with arbitrary a priori probabilities. FRIO discrimination interpolates between minimum error (ME) and unambiguous state discrimination (UD). ME and UD are well known discrimination protocols with several applications in quantum information theory. FRIO discrimination provides a more general framework where the discrimination process together with its applications can be studied. In this setting, we compared the performance of optimum probability of discrimination, mutual information, and quantum discord. We found that the accessible information is obtained when Bob implements the ME strategy. The most (least) efficient discrimination scheme is ME (UD), from the point of view of correlations that are lost in the initial state and remain in the final state, after Bob's measurement.

Bell Diagonal and Werner State Generation: Entanglement, Non-Locality, Steering and Discord on the IBM Quantum Computer.

We propose the first correct special-purpose quantum circuits for preparation of Bell diagonal states (BDS), and implement them on the IBM Quantum computer, characterizing and testing complex aspects of their quantum correlations in the full parameter space. Among the circuits proposed, one involves only two quantum bits but requires adapted quantum tomography routines handling classical bits in parallel. The entire class of Bell diagonal states is generated, and several characteristic indicators, namely entanglement of formation and concurrence, CHSH non-locality, steering and discord, are experimentally evaluated over the full parameter space and compared with theory. As a by-product of this work, we also find a remarkable general inequality between "quantum discord" and "asymmetric relative entropy of discord": the former never exceeds the latter. We also prove that for all BDS the two coincide.

A Computable Gaussian Quantum Correlation for Continuous-Variable Systems.

Generally speaking, it is difficult to compute the values of the Gaussian quantum discord and Gaussian geometric discord for Gaussian states, which limits their application. In the present paper, for any (n+m)-mode continuous-variable system, a computable Gaussian quantum correlation M is proposed. For any state ρAB of the system, M(ρAB) depends only on the covariant matrix of ρAB without any measurements performed on a subsystem or any optimization procedures, and thus is easily computed. Furthermore, M has the following attractive properties: (1) M is independent of the mean of states, is symmetric about the subsystems and has no ancilla problem; (2) M is locally Gaussian unitary invariant; (3) for a Gaussian state ρAB, M(ρAB)=0 if and only if ρAB is a product state; and (4) 0≤M((ΦA⊗ΦB)ρAB)≤M(ρAB) holds for any Gaussian state ρAB and any Gaussian channels ΦA and ΦB performed on the subsystem A and B, respectively. Therefore, M is a nice Gaussian correlation which describes the same Gaussian correlation as Gaussian quantum discord and Gaussian geometric discord when restricted on Gaussian states. As an application of M, a noninvasive quantum method for detecting intracellular temperature is proposed.

Quantum Euler Relation for Local Measurements.

In classical thermodynamics the Euler relation is an expression for the internal energy as a sum of the products of canonical pairs of extensive and intensive variables. For quantum systems the situation is more intricate, since one has to account for the effects of the measurement back action. To this end, we derive a quantum analog of the Euler relation, which is governed by the information retrieved by local quantum measurements. The validity of the relation is demonstrated for the collective dissipation model, where we find that thermodynamic behavior is exhibited in the weak-coupling regime.

Poor family relationships in adolescence as a risk factor of in-patient psychiatric care across the life course: A prospective cohort study.

Background: Previous research has shown that poor family relations in childhood are associated with adverse mental health in adulthood. Yet, few studies have followed the offspring until late adulthood, and very few have had access to register-based data on hospitalisation due to psychiatric illness. The aim of this study was to examine the association between poor family relations in adolescence and the likelihood of in-patient psychiatric care across the life course up until age 55. Methods: Data were derived from the Stockholm Birth Cohort study, with information on 2638 individuals born in 1953. Information on family relations was based on interviews with the participants' mothers in 1968. Information on in-patient psychiatric treatment was derived from administrative registers from 1969 to 2008. Binary logistic regression was used. Results: Poor family relations in adolescence were associated with an increased risk of later in-patient treatment for a psychiatric diagnosis, even when adjusting for other adverse conditions in childhood. Further analyses showed that poor family relations in adolescence were a statistically significant predictor of in-patient psychiatric care up until age 36-45, but that the strength of the association attenuated over time. Conclusions: Poor family relationships during upbringing can have serious negative mental-health consequences that persist into mid-adulthood. However, the effect of poor family relations seems to abate with age. The findings point to the importance of effective interventions in families experiencing poor relationships.

Analytic Expression of Quantum Discords in Werner States under LQCC.

In this paper, quantum discords in a special kind of states, i.e., Werner states by local quantum operations and classical communication (LQCC) protocols (WLQCC states), are studied. Nineteen parameters to quantify the quantum discords are reduced to four parameters in terms of properties of Werner states and quantum discord. In the case of orthogonal projective measures, analytic expression of quantum discords in WLQCC states is analytically worked out. Some properties of the quantum discord in the WLQCC states are obtained, especially the variation relations between the quantum discords and the parameters characterizing the WLQCC states. By virtue of numerical computations, quantum discords in a Werner state before and after LQCC protocols are compared. It is found that quantum discord in any WLQCC state cannot exceed that in the original Werner state.

Quantum Correlation Dynamics in Controlled Two-Coupled-Qubit Systems.

We study and compare the time evolutions of concurrence and quantum discord in a driven system of two interacting qubits prepared in a generic Werner state. The corresponding quantum dynamics is exactly treated and manifests the appearance and disappearance of entanglement. Our analytical treatment transparently unveils the physical reasons for the occurrence of such a phenomenon, relating it to the dynamical invariance of the X structure of the initial state. The quantum correlations which asymptotically emerge in the system are investigated in detail in terms of the time evolution of the fidelity of the initial Werner state.

The Discord Outcome Analysis (DOA) as a Reporting Standard at Three Months and Five Years in Randomised Varicose Vein Treatment Trials.

OBJECTIVES: Treatment success for chronic superficial venous insufficiency could be defined as an improvement in three domains: (i) disease specific quality of life, (ii) clinical severity, (iii) reflux. The aim was to report these at five years using a Venn diagram to profile the outcomes: a discord outcome analysis (DOA). METHODS: Patients (n = 50 patients/legs in each treated group) were randomised to endovenous laser ablation (EVLA) with concurrent phlebectomies vs. ultrasound guided foam sclerotherapy (UGFS). Outcomes were assessed using three domains: (i) Aberdeen varicose vein questionnaire (AVVQ), (ii) venous clinical severity score (VCSS), (iii) venous filling index (VFI) of air plethysmography. Change scores were calculated by subtracting the final score after treatment from the baseline score before treatment to quantify the improvement. This was followed by a DOA profile for each patient where a discord was defined as the percentage of patients with a numerical deterioration in one or two domains. RESULTS: The median [interquartile range] follow up was 68 [64-72] months. Follow up in all three domains was EVLA: 45/50, UGFS: 42/50. On ultrasound examination, GSV occlusion at some point above the knee was 93% for EVLA and 64% for UGFS (p = .001). There was no significant difference in improvement between the two treatment groups in the VCSS and the VFI. However, the EVLA group had a statistically significant AVVQ improvement (p = .004). Using a DOA, only 76% EVLA versus 60% UGFS had success in all three domains. Using improvement thresholds, this reduced to 54% and 39%, respectively. The commonest discord pattern was an improvement in the VCSS and VFI but deterioration in the AVVQ. CONCLUSIONS: A DOA demonstrated that the definition of success is reduced if deterioration in one or two domains is taken into account. A DOA should be considered as a reporting standard for comparative analyses.

A Customized Social Network Platform (Kids Helpline Circles) for Delivering Group Counseling to Young People Experiencing Family Discord That Impacts Their Well-Being: Exploratory Study.

BACKGROUND: It has often been reported that young people are at high risk of mental health concerns, more so than at any other time in development over their life span. The situational factors that young people report as impacting their well-being are not addressed as often: specifically, family discord. Kids Helpline, a national service in Australia that provides free counseling online and by telephone to young people in distress, report that family discord and well-being issues are one of the major concerns reported by clients. In order to meet the preferences that young people seek when accessing counseling support, Kids Helpline has designed and trialed a custom-built social network platform for group counseling of young people experiencing family discord that impacts their well-being. OBJECTIVE: In this exploratory study, we communicate the findings of Phase 1 of an innovative study in user and online counselor experience. This will lead to an iterative design for a world-first, purpose-built social network that will do the following: (1) increase reach and quality of service by utilizing a digital tool of preference for youth to receive peer-to-peer and counselor-to-peer support in a safe online environment and (2) provide the evidence base to document the best practice for online group counseling in a social network environment. METHODS: The study utilized a participatory action research design. Young people aged 13-25 years (N=105) with mild-to-moderate depression or anxiety (not high risk) who contacted Kids Helpline were asked if they would like to trial the social networking site (SNS) for peer-to-peer and counselor-to-peer group support. Subjects were grouped into age cohorts of no more than one year above or below their reported age and assigned to groups of no more than 36 participants, in order to create a community of familiarity around age and problems experienced. Each group entered into an 8-week group counseling support program guided by counselors making regular posts and providing topic-specific content for psychoeducation and discussion. Counselors provided a weekly log of events to researchers; at 2-week intervals, subjects provided qualitative and quantitative feedback through open-ended questions and specific psychometric measures. RESULTS: Qualitative results provided evidence of user support and benefits of the online group counseling environment. Counselors also reported benefits of the modality of therapy delivery. Psychometric scales did not report significance in changes of mood or affect. Counselors and users suggested improvements to the platform to increase user engagement. CONCLUSIONS: Phase 1 provided proof of concept for this mode of online counseling delivery. Users and counselors saw value in the model and innovation of the service. Phase 2 will address platform issues with changes to a new social network platform. Phase 2 will focus more broadly on mental health concerns raised by users and permit inclusion of a clinical population of young people experiencing depression and anxiety. TRIAL REGISTRATION: Australian New Zealand Clinical Trials Registry (ANZCTR) ACTRN12616000518460; https://www.anzctr.org.au/Trial/Registration/TrialReview.aspx?id=370381.

Quantum Discord, Thermal Discord, and Entropy Generation in the Minimum Error Discrimination Strategy.

We study the classical and quantum correlations in the minimum error discrimination (ME) of two non-orthogonal pure quantum states. In particular, we consider quantum discord, thermal discord and entropy generation. We show that ME allows one to reach the accessible information between the two involved parties, Alice and Bob, in the discrimination process. We determine the amount of quantum discord that is consumed in the ME and show that the entropy generation is, in general, higher than the thermal discord. However, in certain cases the entropy generation is very close to thermal discord, which indicates that, in these cases, the process generates the least possible entropy. Moreover, we also study the ME process as a thermodynamic cycle and we show that it is in agreement with the second law of thermodynamics. Finally, we study the relation between the accessible information and the optimum success probability in ME.

Multi-locus reassessment of a striking discord between mtDNA gene trees and taxonomy across two congeneric species complexes.

Resolving relationships among members of the yellow and citrine wagtail species complexes is among the greatest challenges in avian systematics due to arguably the most dramatic disagreements between traditional taxonomy and mtDNA phylogeny. Each species complex is divided into three geographically cohesive mtDNA clades. Each clade from one species complex has a sister from the other complex. Furthermore, one cross-complex pair is more distantly related to the remaining two pairs than are several other wagtail species. To test mtDNA gene tree topology, we sequenced the mtDNA ND2 gene and 11 nuclear introns for seven wagtail species. Our mtDNA gene tree reconstruction supported the results of previous studies, thereby confirming the disagreement between mtDNA phylogeny and taxonomy. However, our multi-locus species tree which used mtDNA clades as "taxa" was consistent with traditional taxonomy regardless of whether mtDNA was included in the analysis or not. Our multi-locus data suggest that despite the presence of strongly supported, geographically structured mtDNA variation, the mtDNA gene tree misrepresents the evolutionary history of the yellow and citrine wagtail complexes. This mito-nuclear discord results from mtDNA representing the biogeographic, but not evolutionary history of these recently radiated Palearctic wagtails.

A matter of phylogenetic scale: Distinguishing incomplete lineage sorting from lateral gene transfer as the cause of gene tree discord in recent versus deep diversification histories.

PREMISE OF THE STUDY: Discordant gene trees are commonly encountered when sequences from thousands of loci are applied to estimate phylogenetic relationships. Several processes contribute to this discord. Yet, we have no methods that jointly model different sources of conflict when estimating phylogenies. An alternative to analyzing entire genomes or all the sequenced loci is to identify a subset of loci for phylogenetic analysis. If we can identify data partitions that are most likely to reflect descent from a common ancestor (i.e., discordant loci that indeed reflect incomplete lineage sorting [ILS], as opposed to some other process, such as lateral gene transfer [LGT]), we can analyze this subset using powerful coalescent-based species-tree approaches. METHODS: Test data sets were simulated where discord among loci could arise from ILS and LGT. Data sets where analyzed using the newly developed program CLASSIPHY (Huang et al., ) to assess whether our ability to distinguish the cause of discord among loci varied when ILS and LGT occurred in the recent versus deep past and whether the accuracy of these inferences were affected by the mutational process. KEY RESULTS: We show that accuracy of probabilistic classification of individual loci by the cause of discord differed when ILS and LGT events occurred more recently compared with the distant past and that the signal-to-noise ratio arising from the mutational process contributes to difficulties in inferring LGT data partitions. CONCLUSIONS: We discuss our findings in terms of the promise and limitations of identifying subsets of loci for species-tree inference that will not violate the underlying coalescent model (i.e., data partitions in which ILS, and not LGT, contributes to discord). We also discuss the empirical implications of our work given the many recalcitrant nodes in the tree of life (e.g., origins of angiosperms, amniotes, or Neoaves), and recent arguments for concatenating loci.