Molecular classification of endometrial cancer: preliminary experience from a single Portuguese academic center.

Background: Since the seminal publication of the TCGA consortium in 2013, the molecular classification of endometrial cancer has been widely accepted as a new and powerful tool to better understand the natural history of this malignancy. Adoption of routine molecular classification around the world has been limited. We sought to demonstrate our initial experience in incorporating the four molecular subtypes for endometrioid carcinomas. Methods: This was a retrospective analysis at a single center in Portugal. Molecular classification was determined using immunohistochemical staining for MMR and p53 and Sanger Sequencing to determine POLE mutation status as per published PROMISE method. Descriptive statistics were reported. Results: 20 patients with endometrioid histology were included. Median age of the cohort was 64 years (range 45-76). Median Body Mass Index (kg/m2) was 29.81 (range 21.3-43.1). In terms of tumor grading, 16 (80%) of the endometrial carcinomas of the cohort were low-grade (either grade 1 or grade 2). 16 (80%) of the cases were FIGO stage I. Regarding the molecular classification the tumors were classified as: MMRd [n = 6 (30%)]; p53 abn [n = 2 (10%)]; NSMP (n = 10 (50%)), POLE ultramut [n = 2 (10%)]. Conclusion: Despite the small sample size, we were able to show that molecular classification is feasible. To our knowledge this is the first cohort of endometroid endometrial carcinomas fully characterized according to the TCGA classification in Portugal, from one single center.

Aerosolization of micro- and nanoplastics via sea spray: Investigating the role of polymer type, size, and concentration, and potential implications for human exposure.

Micro- and nanoplastics (MNPs) can enter the atmosphere via sea spray aerosols (SSAs), but the effects of plastic characteristics on the aerosolization process are unclear. Furthermore, the importance of the transport of MNPs via these SSAs as a possible new exposure route for human health remains unknown. The aim of this study was two-fold: (1) to examine if a selection of factors affects aerosolization processes of MNPs, and (2) to estimate human exposure to MNPs via aerosols inhalation. A laboratory-based bubble bursting mechanism, simulating the aerosolization process at sea, was used to investigate the influence of MNP as well as seawater characteristics. To determine the potential human exposure to microplastics via inhalation of SSAs, the results of the laboratory experiments were extrapolated to the field based on sea surface microplastic concentrations and the volume of inhaled aerosols. Enrichment seemed to be influenced by MNP size, concentration and polymer type. With higher enrichment for smaller particles and denser polymers. Experiments with different concentrations showed a larger range of variability but nonetheless lower concentrations seemed to result in higher enrichment, presumably due to lower aggregation. In addition to the MNP characteristics, the type of seawater used seemed to influence the aerosolization process. Our human exposure estimate to microplastic via inhalation of sea spray aerosols shows that in comparison with reported inhaled concentrations in urban and indoor environments, this exposure route seems negligible for microplastics. Following the business-as-usual scenario on plastic production, the daily plastic inhalation in coastal areas in 2100 is estimated to increase but remain far below 1 particle per day. This study shows that aerosolization of MNPs is a new plastic transport pathway to be considered, but in terms of human exposure it seems negligible compared to other more important sources of MNPs, based on current reported environmental concentrations.

Application of three-dimensional imaging software to map carcinomatosis in recurrent ovarian cancer.

The treatment of recurrent ovarian cancer has been based on systemic therapy. The role of secondary cytoreductive surgery has been addressed recently in several trials. Imaging plays a key role in helping the surgical team to decide which patients will have resectable disease and benefit from surgery. The role of staging laparoscopy and several imaging and clinical scores has been extensively debated in the field. In other surgical fields there have been reports of using 3D imaging software and 3D printed models to help surgeons better plan the surgical approach. To the best of our knowledge, we report the first case of a patient with recurrent ovarian cancer undergoing 3D modeling before secondary cytoreductive surgery. The 3D modeling was of most value to evaluate the extension of the disease in our patient who underwent a successful secondary cytoreductive surgery and is currently free of the disease.

A Case of Amyloid Goitre in Heavy Chain Amyloidosis: Diagnostic Challenges and Clinical Implications.

Immunoglobulin heavy chain amyloidosis (AH amyloidosis) is an extremely rare subtype of immunoglobulin-derived amyloidosis and there is limited literature on how to diagnose and manage this disorder. We describe a rare case of AH amyloidosis with amyloid goitre and the importance of mass spectrometry in the identification of the different types of amyloids. While additional studies are needed, several observations suggest important practical implications, including differences in clinical picture, prognosis, and pathologic diagnosis. LEARNING POINTS: Immunoglobulin heavy chain amyloidosis is an extremely rare subtype of immunoglobulin-derived amyloidosis and amyloid goitre is even rarer.There is limited literature on how to diagnose and manage this disorder.This case portrays one of these cases - one of the few existing in the literature - and reinforces the diagnostic complexity of this entity.

A deep learning quantification of patient specificity as a predictor of session attendance and treatment response to internet-enabled cognitive behavioural therapy for common mental health disorders.

BACKGROUND: Increasing an individual's ability to focus on concrete, specific detail, thus reducing the tendency toward overly broad, decontextualised generalisations about the self and world, is a target within cognitive behavioural therapy (CBT). However, empirical investigation of the impact of within-treatment specificity on treatment outcomes is scarce. We evaluated whether the specificity of patient dialogue predicted a) end-of-treatment symptoms and b) session completion for CBT for common mental health issues. METHODS: This preregistered (https://osf.io/agr4t) study trained a deep learning model to score the specificity of patient dialogue in transcripts from 353,614 internet-enabled CBT sessions for common mental health disorders, delivered on behalf of UK NHS services. Data were from obtained from 65,030 participants (n = 47,308 female, n = 241 unstated) aged 18-94 years (M = 34.69, SD = 12.35). Depressive disorders were the most common (39.1 %) primary diagnosis. Primary outcome was end-of-treatment score on the Patient Health Questionnaire-9 (PHQ-9). Secondary outcome was number of sessions attended. RESULTS: Linear mixed-effects models demonstrated that increased patient specificity significantly predicted lower post-treatment symptoms on the PHQ-9, although the size and direction of the effect varied depending on the type of therapeutic activity being completed. Effect sizes were consistently small. Higher patient specificity was associated with completing a greater number of sessions. LIMITATIONS: We are unable to infer causation from our data. CONCLUSIONS: Although effect sizes were small, an effect of specificity was observed across common mental health disorders. Further studies are needed to explore whether encouraging patient specificity during CBT may provide an enhancement of treatment attendance and treatment effects.

Accelerated fragmentation of two thermoplastics (polylactic acid and polypropylene) into microplastics after UV radiation and seawater immersion.

To better understand the fate and assess the ingestible fraction of microplastics (by aquatic organisms), it is essential to quantify and characterize of their released from larger items under environmental realistic conditions. However, the current information on the fragmentation and size-based characteristics of released microplastics, for example from bio-based thermoplastics, is largely unknown. The goal of our work was to assess the fragmentation and release of microplastics, under ultraviolet (UV) radiation and in seawater, from polylactic acid (PLA) items, a bio-based polymer, and from polypropylene (PP) items, a petroleum-based polymer. To do so, we exposed pristine items of PLA and PP, immersed in filtered natural seawater, to accelerated UV radiation for 57 and 76 days, simulating 18 and 24 months of mean natural solar irradiance in Europe. Our results indicated that 76-day UV radiation induced the fragmentation of parent plastic items and the microplastics (50 - 5000 µm) formation from both PP and PLA items. The PP samples (48 ± 26 microplastics / cm2) released up to nine times more microplastics than PLA samples (5 ± 2 microplastics / cm2) after a 76-day UV exposure, implying that the PLA tested items had a lower fragmentation rate than PP. The particles' length of released microplastics was parameterized using a power law exponent (α), to assess their size distribution. The obtained α values were 3.04 ± 0.11 and 2.54 ± 0.06 (-) for 76-day UV weathered PP and PLA, respectively, meaning that PLA microplastics had a larger sized microplastics fraction than PP particles. With respect to their two-dimensional shape, PLA microplastics also had lower width-to-length ratio (0.51 ± 0.17) and greater fiber-shaped fractions (16%) than PP microplastics (0.57 ± 0.17% and 11%, respectively). Overall, the bio-based PLA items under study were more resistant to fragmentation and release of microplastics than the petroleum-based PP tested items, and the parameterized characteristics of released microplastics were polymer-dependent. Our work indicates that even though bio-based plastics may have a slower release of fragmented particles under UV radiation compared to conventional polymer types, they still have the potential to act as a source of microplastics in the marine environment, with particles being available to biota within ingestible size fractions, if not removed before major fragmentation processes.

Prognosis of polymerase epsilon (POLE) mutation in high-grade endometrioid endometrial cancer: Systematic review and meta-analysis.

BACKGROUND: POLE mutated endometrial carcinomas may represent a subspecific type of tumors harboring a more favorable prognosis. Grade 3 (G3 or high-grade) endometrioid endometrial carcinomas remain a clinical dilemma, with some tumors behaving as the low-grade counterparts and others presenting a more aggressive behavior. OBJECTIVES: To determine the association between POLE mutational status and the overall-survival (OS) and progression-free-survival (PFS) of patients with G3 endometrioid endometrial cancer (EC). We also aimed to determine the prevalence of POLE mutations in G3 endometrioid EC. METHODS: We conducted a systematic review in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines (PROSPERO No: CRD4202340008). We searched the following electronic databases: PubMed/Medline, EMBASE, Cochrane Library, Scopus, and Web of Science. For time-to-event data, the effect of POLE mutation in G3 EC was described using hazard ratios (HRs) and corresponding 95% confidence intervals (CIs). Individual patient data for each study was investigated if available from the study authors. If individual patient data were not available, information regarding time-to-event outcomes was extracted using an appropriate methodology. OS and PFS were analyzed using both one-stage and two-stage approaches, the Kaplan-Meier method, and Cox-proportional hazards models. RESULTS: This systematic review and meta-analysis included 19 studies with 3092 patients who had high-grade endometrioid EC. Patients with POLE mutations had lower risks of death (HR = 0.36, 95% CI 0.26 to 0.50, I2 = 0%, 10 trials) and disease progression (HR = 0.31, 95% CI 0.17 to 0.57, I2 = 33%, 10 trials). The pooled prevalence of POLE mutation was 11% (95% CI 9 to 13, I2 = 68%, 18 studies). CONCLUSION: POLE mutations in high-grade endometrioid EC are associated with a more favorable prognosis with increased OS and PFS.

Trajectories of depression symptoms, anxiety symptoms and functional impairment during internet-enabled cognitive-behavioural therapy.

Underlying classes capture differences between patient symptom trajectories during psychological therapy. This has not been explored for one-to-one internet-delivered therapy or functional impairment trajectories. Patients experiencing depression or anxiety received cognitive-behavioural therapy with a therapist using an online chat platform (N = 52,029). Trajectory classes of depression symptoms (PHQ9), anxiety symptoms (GAD7) and functional impairment (WSAS) were investigated using growth mixture modelling. Multinomial regressions tested associations between baseline variables and trajectory class. A four-class trajectory model was selected for each outcome, and these were highly similar. Each outcome showed three classes with initially moderate-severe symptoms or impairment: one demonstrated no change, one gradual improvement and one fast improvement. A fourth class had mild baseline scores and minimal improvement. In the moderate-severe classes, patients in the two with improvement were more likely to be employed and not to have obsessive-compulsive disorder. Fast improvement was likelier than gradual improvement or no change for patients with older age, no disability (e.g., physical, learning), or lower comorbid symptom or impairment scores. Associations with functional impairment classes were more similar to associations with depression classes than anxiety classes. Results were largely consistent with findings from face-to-face therapy. This study is an important step towards personalising therapy in terms of suitability and continuation.

Impact of the citizen science project COLLECT on ocean literacy and well-being within a north/west African and south-east Asian context.

Plastic pollution is both a societal and environmental problem and citizen science has shown to be a useful tool to engage both the public and professionals in addressing it. However, knowledge on the educational and behavioral impacts of citizen science projects focusing on marine litter remains limited. Our preregistered study investigates the impact of the citizen science project Citizen Observation of Local Litter in coastal ECosysTems (COLLECT) on the participants' ocean literacy, pro-environmental intentions and attitudes, well-being, and nature connectedness, using a pretest-posttest design. A total of 410 secondary school students from seven countries, in Africa (Benin, Cabo Verde, Côte d'Ivoire, Ghana, Morocco, Nigeria) and Asia (Malaysia) were trained to sample plastics on sandy beaches and to analyze their collection in the classroom. Non-parametric statistical tests (n = 239 matched participants) demonstrate that the COLLECT project positively impacted ocean literacy (i.e., awareness and knowledge of marine litter, self-reported litter-reducing behaviors, attitudes towards beach litter removal). The COLLECT project also led to higher pro-environmental behavioral intentions for students in Benin and Ghana (implying a positive spillover effect) and higher well-being and nature connectedness for students in Benin. Results are interpreted in consideration of a high baseline in awareness and attitudes towards marine litter, a low internal consistency of pro-environmental attitudes, the cultural context of the participating countries, and the unique settings of the project's implementation. Our study highlights the benefits and challenges of understanding how citizen science impacts the perceptions and behaviors towards marine litter in youth from the respective regions.

Micro- and nanoplastics transfer from seawater to the atmosphere through aerosolization under controlled laboratory conditions.

Sea spray has been suggested to enable the transfer of micro- and nanoplastics (MNPs) from the ocean to the atmosphere, but only a few studies support the role of sea spray aerosols (SSAs) as a source of airborne particles. We demonstrated that MNPs are aerosolized during wave action, via SSAs, under controlled laboratory conditions. We used a mini-Marine-Aerosol-Reference-Tank (miniMART), a device that mimics naturally occurring physical mechanisms producing SSAs, and assessed the aerosolization of fluorescent polystyrene beads (0.5-10 µm), in artificial seawater. The SSAs contained up to 18,809 particles/mL of aerosols for 0.5 µm beads, with an enrichment factor of 19-fold, and 1977 particles/mL of aerosols for 10 µm beads with a 2-fold enrichment factor. Our study demonstrates that the use of the miniMART is essential to assess MNPs aerosolization in a standardized way, supporting the hypothesis which states that MNPs in the surface of the ocean may be transferred to the atmosphere.

A comprehensive assessment of plastic remediation technologies.

The global presence of plastic litter and its accumulation in the environment has become an issue of concern to the public and policymakers. This concern has triggered innovators in past decades to design and develop a multitude of remediation technologies to prevent plastic from entering the environment, or to clean up legacy litter. This study aims to (i) systematically review the current scientific literature on plastic remediation technologies, (ii) create a 'plastic clean-up and prevention overview' illustrating 124 remediation technologies and 29 characteristics, (iii) qualitatively analyse their key characteristics (e.g., fields of application, targeted plastic), and (iv) investigate challenges and opportunities of clean-up technologies for inland waterways (e.g., canals, rivers) and ports. We identified 61 scientific publications on plastic remediation technologies, until June 2022. Thirty-four of these studies were published within the last three years, demonstrating a growing interest. The presented overview indicates that inland waterways are, so far, the preferred field of application, with 22 technologies specifically designed for cleaning up plastics from inland waterways, and 52 additional ones with the potential to be installed in these locations. Given the importance of clean-up technologies in inland waterways, we highlighted their strengths, weaknesses, opportunities, and threats (SWOT). Our results indicate that, despite the challenges, these technologies provide essential prospects, from improving the environmental quality to raising awareness. Our study is instrumental as it illustrates an up-to-date overview and provides a comprehensive analysis of current in design phase, testing, and in use plastic remediation technologies.

The Role of Cell Cycle Arrest Biomarkers for Predicting Acute Kidney Injury in Critically Ill COVID-19 Patients: A Multicenter, Observational Study.

OBJECTIVES: Patients with COVID-19-associated acute respiratory distress syndrome (ARDS) have a high risk for developing acute kidney injury (AKI) which is associated with an increased risk of death and persistent renal failure. Early prediction of AKI is crucial in order to implement preventive strategies. The purpose of this study was to investigate the predictive performance of tissue inhibitor of metalloproteinases 2 and insulin like growth factor binding protein 7 (TIMP-2) × (IGFBP7) in critically ill patients with COVID-19-associated ARDS. DESIGN: Multicenter, prospective, observational study. SETTING: Twelve centers across Europe and United Kingdom. PATIENTS: Patients with moderate or severe COVID-19-associated ARDS were included and serial measurements of (TIMP-2) × (IGFBP7) were performed. INTERVENTIONS: None. MEASUREMENTS AND MAIN RESULTS: The primary endpoint was the development of moderate or severe AKI according to the Kidney Disease: Improving Global Outcomes definition. Three hundred patients were available for the primary analysis, and 39 met the primary endpoint. At enrollment, urinary (TIMP-2) × (IGFBP7) had high predictive value for the primary endpoint with an area under the receiver operating characteristic curve of 0.89 (95% CI, 0.84-0.93). (TIMP-2) × (IGFBP7) was significantly higher in endpoint-positive patients at enrollment and at 12 hours. CONCLUSIONS: Urinary (TIMP-2) × (IGFBP7) predicts the occurrence of AKI in critically ill patients with COVID-19-associated ARDS.

The ecotoxicological consequences of microplastics and co-contaminants in aquatic organisms: a mini-review.

Microplastics (MPs, <5 mm in size) are a grave environmental concern. They are a ubiquitous persistent pollutant group that has reached into all parts of the environment - from the highest mountain tops to the depths of the ocean. During their production, plastics have added to them numerous chemicals in the form of plasticizers, colorants, fillers and stabilizers, some of which have known toxicity to biota. When released into the environments, MPs are also likely to encounter chemical contaminants, including hydrophobic organic contaminants, trace metals and pharmaceuticals, which can sorb to plastic surfaces. Additionally, MPs have been shown to be ingested by a wide range of organisms and it is this combination of ingestion and chemical association that gives weight to the notion that MPs may impact the bioavailability and toxicity of both endogenous and exogenous co-contaminants. In this mini-review, we set the recent literature within what has been previously published about MPs as chemical carriers to biota, with particular focus on aquatic invertebrates and fish. We then present a critical viewpoint on the validity of laboratory-to-field extrapolations in this area. Lastly, we highlight the expanding 'microplastic universe' with the addition of anthropogenic particles that have gained recent attention, namely, tire wear particles, nanoplastics and, bio-based or biodegradable MPs, and highlight the need for future research in their potential roles as vehicles of co-contaminant transfer.

How science outreach with children can promote equity and diversity.

Science outreach is key to closing the gap between science and society. However, it often fails to reach those who feel excluded from science or are dismissive of it. By sharing our experience at Native Scientist, we demonstrate how outreach activities can help improve equity, diversity, and inclusion (EDI).

Microplastic detection and identification by Nile red staining: Towards a semi-automated, cost- and time-effective technique.

Microplastic pollution is an issue of concern due to the accumulation rates in the marine environment combined with the limited knowledge about their abundance, distribution and associated environmental impacts. However, surveying and monitoring microplastics in the environment can be time consuming and costly. The development of cost- and time-effective methods is imperative to overcome some of the current critical bottlenecks in microplastic detection and identification, and to advance microplastics research. Here, an innovative approach for microplastic analysis is presented that combines the advantages of high-throughput screening with those of automation. The proposed approach used Red Green Blue (RGB) data extracted from photos of Nile red-fluorescently stained microplastics (50-1200 µm) to train and validate a 'Plastic Detection Model' (PDM) and a 'Polymer Identification Model' (PIM). These two supervised machine learning models predicted with high accuracy the plastic or natural origin of particles (95.8%), and the polymer types of the microplastics (88.1%). The applicability of the PDM and the PIM was demonstrated by successfully using the models to detect (92.7%) and identify (80%) plastic particles in spiked environmental samples that underwent laboratorial processing. The classification models represent a semi-automated, high-throughput and reproducible method to characterize microplastics in a straightforward, cost- and time-effective yet reliable way.

Integrating Bayesian Belief Networks in a toolbox for decision support on plastic clean-up technologies in rivers and estuaries.

Current mitigation strategies to offset marine plastic pollution, a global concern, typically rely on preventing floating debris from reaching coastal ecosystems. Specifically, clean-up technologies are designed to collect plastics by removing debris from the aquatic environment such as rivers and estuaries. However, to date, there is little published data on their potential impact on riverine and estuarine organisms and ecosystems. Multiple parameters might play a role in the chances of biota and organic debris being unintentionally caught within a mechanical clean-up system, but their exact contribution to a potential impact is unknown. Here, we identified four clusters of parameters that can potentially determine the bycatch: (i) the environmental conditions in which the clean-up system is deployed, (ii) the traits of the biota the system interacts with, (iii) the traits of plastic items present in the system, and, (iv) the design and operation of the clean-up mechanism itself. To efficiently quantify and assess the influence of each of the clusters on bycatch, we suggest the use of transparent and objective tools. In particular, we discuss the use of Bayesian Belief Networks (BBNs) as a promising probabilistic modelling method for an evidence-based trade-off between removal efficiency and bycatch. We argue that BBN probabilistic models are a valuable tool to assist stakeholders, prior to the deployment of any clean-up technology, in selecting the best-suited mechanism to collect floating plastic debris while managing potential adverse effects on the ecosystem.

The PALliative MUlticenter Study in Intensive Care (PalMuSIC). Results From a Multicenter Study Addressing Frailty and Palliative Care Interventions in Intensive Care Units in Portugal.

Objective: Frailty is a clinically recognizable state of increased vulnerability common in critical medicine. When underrecognized, it may lead to invasive treatments that do not serve the patients' best interest. Our aim was to evaluate the use of both palliative care consultation and invasive interventions in frail patients admitted to Intensive Care Units in Portugal. Methods: This was a prospective, observational study. All consecutive adult patients admitted for more than 24 h, over a 15-day period were enrolled. Twenty-three Portuguese Intensive Care Units were included. Informed consent was obtained from all patients or their surrogate. The doctor and nurse in charge calculated the Clinical Frailty Score as well as the reference family member Results: A total of 335 patients were included in the study (66% male). Mean age was 63.2 ± 16.8 and SAPS II score was 41.8 ± 17.4. Mean Clinical Frailty Score value was 3.5 ± 1.7. Frailty prevalence (mean score ≥ 5) was 20.9%. Frail patients were offered organ support therapy (64,3% invasive mechanical ventilation; 24,3% renal replacement therapy; 67,1% vasopressors) more often than non-frail patients. Nevertheless, limitation of therapeutic effort or a do not resuscitate order (p < 0.001) were more common in frail patients. Mortality rate by 6 months was higher among frail patients (50% vs. 32.3%, p < 0.001). Palliative Care was offered to only 15% of frail patients (3.9% overall). Conclusions: The authors suggest that palliative care should be universally consulted once frailty is identified in critical patients.

Refining our understanding of depressive states and state transitions in response to cognitive behavioural therapy using latent Markov modelling.

BACKGROUND: It is increasingly recognized that existing diagnostic approaches do not capture the underlying heterogeneity and complexity of psychiatric disorders such as depression. This study uses a data-driven approach to define fluid depressive states and explore how patients transition between these states in response to cognitive behavioural therapy (CBT). METHODS: Item-level Patient Health Questionnaire (PHQ-9) data were collected from 9891 patients with a diagnosis of depression, at each CBT treatment session. Latent Markov modelling was used on these data to define depressive states and explore transition probabilities between states. Clinical outcomes and patient demographics were compared between patients starting at different depressive states. RESULTS: A model with seven depressive states emerged as the best compromise between optimal fit and interpretability. States loading preferentially on cognitive/affective v. somatic symptoms of depression were identified. Analysis of transition probabilities revealed that patients in cognitive/affective states do not typically transition towards somatic states and vice-versa. Post-hoc analyses also showed that patients who start in a somatic depressive state are less likely to engage with or improve with therapy. These patients are also more likely to be female, suffer from a comorbid long-term physical condition and be taking psychotropic medication. CONCLUSIONS: This study presents a novel approach for depression sub-typing, defining fluid depressive states and exploring transitions between states in response to CBT. Understanding how different symptom profiles respond to therapy will inform the development and delivery of stratified treatment protocols, improving clinical outcomes and cost-effectiveness of psychological therapies for patients with depression.

Depression subtypes and their response to cognitive behavioral therapy: A latent transition analysis.

BACKGROUND: Depression is a heterogeneous condition, with multiple possible symptom-profiles leading to the same diagnosis. Descriptive depression subtypes based on observation and theory have so far proven to have limited clinical utility. AIM: To identify depression subtypes and to examine their time-course and prognosis using data-driven methods. METHODS: Latent transition analysis was applied to a large (N = 8380) multi-service sample of depressed patients treated with cognitive behavioral therapy (CBT) in outpatient clinics. Patients were classed into initial latent states based on their responses to the Patient Health Questionnaire-9 of depression symptoms, and transition probabilities to other states during treatment were quantified. Qualitatively similar states were clustered into overarching depression subtypes and we statistically compared indices of treatment engagement and outcomes between subtypes using post hoc analyses. RESULTS: Fourteen latent states were clustered into five depression subtypes: mild (2.7%), severe (9.8%), cognitive-affective (23.7%), somatic (21.4%), and typical (42.4%). These subtypes had high temporal stability, and the most common transitions during treatment were from severe toward milder states within the same subtype. Differential response to treatment was evident, with the highest improvement rate (63.6%) observed in the cognitive-affective subtype. CONCLUSION: Replicated evidence indicates that depression subtypes are temporally stable and associated with differential response to CBT.

Long-term durability and ecotoxicity of biocomposites in marine environments: a review.

There is a growing interest in replacing fossil-based polymers and composites with more sustainable and renewable fully biobased composite materials in automotive, aerospace and marine applications. There is an effort to develop components with a reduced carbon footprint and environmental impact, and materials based on biocomposites could provide such solutions. Structural components can be subjected to different marine conditions, therefore assessment of their long-term durability according to their marine applications is necessary, highlighting related degradation mechanisms. Through an up-to-date review, this work critically discusses relevant literature on the long-term durability of biocomposites specific for marine environments. Importantly, in this review we report the effects of abiotic parameters, such as the influence of hygrothermal exposures (temperatures and UV radiation) on physical, mechanical and thermal characteristics of biocomposites. Furthermore, we identify and discuss the potential ecotoxicological effects of leaching substances and microplastics derived from biocomposites, as well as the change in mechanical, physical and thermal behaviours correlated to degradation in the fibre matrix interface, surface defects and overall deterioration of the composite's properties. Finally, the combined effects of various environmental exposures on the long-term durability of the biocomposites are critically reviewed.