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Objective Evaluating the efficacy of an opioid antagonist, naloxone (NLX), to reduce the severity of post‐ictal hypoxemia and immobility after focal to bilateral tonic–clonic seizures (FBTCS). Methods ENALEPSY is a double‐blind placebo (PCB)‐controlled trial conducted in patients with focal epilepsy undergoing long‐term video‐EEG monitoring (LTM). Patients with a FBTCS during LTM were randomized 1:1 to receive intravenous NLX or PCB within the 2 min following the end of FBTCS. After database lock, a discrepancy between the allocated arm and the received treatment was detected, resulting in a 4:1 NLX:PCB ratio. To further explore the efficacy of NLX, we used historical control (HC) data collected in patients included in the REPO2MSE study whose characteristics matched those of patients randomized in ENALEPSY. The efficacy of NLX was then assessed versus PCB and versus HC. The primary endpoint was the delay between the end of the seizure and recovery of SpO2 ≥ 90%. Secondary efficacy outcomes included desaturation nadir and duration of the post‐ictal immobility. Results 33 patients contributed to the NLX group, 7 to the PCB group, and 43 to the HC group. The proportion of FBTCS type 1 or 3 was 84% in NLX, 100% in PCB, and 84% in HC. NLX did not improve the delay of recovery of SpO2 ≥ 90% or the desaturation nadir. By contrast, the duration of the post‐ictal immobility differed across groups. The time to mobility recovery within the first 5 min post‐ictal was very similar in the PCB (200.3 ± 215.8 s) and HC (194.4 ± 192.0 s) groups, and significantly shorter in the NLX group (128.9 ± 151.1 s) when compared to HC (Hazard Ratio, 1.84; 95% CI, 1.11–3.05; p = 0.021). Significance NLX did not prevent post‐ictal respiratory dysfunction but might reduce the duration of post‐ictal immobility. Confirmation of this effect and its impact on SUDEP risk will require additional studies. Plain Language Summary Release of endogenous opioids might participate in the severity of post‐ictal hypoxemia and immobility after focal to bilateral tonic–clonic seizures (FBTCS). We conducted a multicenter double‐blind randomized placebo‐controlled trial evaluating the efficacy of an opioid antagonist, naloxone (NLX), administered within 2 min following the end of FBTCS. The efficacy of NLX was further explored with a comparison with historical control. NLX did not improve the delay of recovery or the severity of post‐ictal hypoxemia. Post‐ictal immobility was significantly shorter in the NLX group when compared to historical control. The impact of these results on SUDEP prevention will require additional studies.

The functional renormalisation group equation is derived in a mathematically rigorous fashion in a framework suitable for the Osterwalder–Schrader formulation of quantum field theory. To this end, we devise a very general regularisation scheme which retains reflection positivity as well as the infinite degrees of freedom including smoothness. Furthermore, it is shown how the classical limit is altered by the regularisation process leading to an inevitable breaking of translation invariance. We also give precise conditions for the convergence of the obtained theories upon removal of the regularisation.

We propose a one-shot, non-cooperative mechanism that implements the core in a large class of public goods games. Players simultaneously choose conditional commitment functions, which are binding unilateral commitments that condition a player’s contribution on the contributions of others. We prove that the set of strong Nash equilibrium outcomes of this mechanism coincides exactly with the core of the underlying cooperative game. We further show that these core outcomes can be found via simple individual learning dynamics.

High-energy completeness of quantum electrodynamics (QED) can be induced by an interacting ultraviolet fixed point of the renormalization flow. We provide evidence for the existence of two of such fixed points in the subspace spanned by the gauge coupling, the electron mass and the Pauli spin-field coupling. Renormalization group trajectories emanating from these fixed points correspond to asymptotically safe theories that are free from the Landau pole problem. We analyze the resulting universality classes defined by the fixed points, determine the corresponding critical exponents, study the resulting phase diagram, and quantify the stability of our results with respect to a systematic expansion scheme. We also compute high-energy complete flows towards the long-range physics. We observe the existence of a renormalization group trajectory that interconnects one of the interacting fixed points with the physical low-energy behavior of QED as measured in experiment. Within pure QED, we estimate the crossover from perturbative QED to the asymptotically safe fixed point regime to occur somewhat above the Planck scale but far below the scale of the Landau pole.

Implicit stochastic models, including both ‘deep neural networks’ (dNNs) and the more recent unsupervised foundational models, cannot be explained. That is, it cannot be determined how they work, because the interactions of the millions or billions of terms that are contained in their equations cannot be captured in the form of a causal model. Because users of stochastic AI systems would like to understand how they operate in order to be able to use them safely and reliably, there has emerged a new field called ‘explainable AI’ (XAI). When we examine the XAI literature, however, it becomes apparent that its protagonists have redefined the term ‘explanation’ to mean something else, namely: ‘interpretation’. Interpretations are indeed sometimes possible, but we show that they give at best only a subjective understanding of how a model works. We propose an alternative to XAI, namely certified AI (CAI), and describe how an AI can be specified, realized, and tested in order to become certified. The resulting approach combines ontologies and formal logic with statistical learning to obtain reliable AI systems which can be safely used in technical applications.

Artificial intelligence (AI) research enjoyed an initial period of enthusiasm in the 1970s and 80s, but this enthusiasm was tempered by a long interlude of frustration when genuinely useful AI applications failed to be forthcoming. Today, we are experiencing once again a period of enthusiasm, fired above all by the successes of the technology of deep neural networks or deep machine learning. In this paper we draw attention to what we take to be serious problems underlying current views of artificial intelligence encouraged by these successes, especially in the domain of language processing. We then show an alternative approach to language-centric AI, in which we identify a role for philosophy.

The golf courses present major areas of grass that need high volumes of water for maintenance. In regions with arid climate, elevated water losses by evapotranspiration contrast with low rainfall. In the urban-touristic area of Los Cabos, 13 golf courses have been built in a distance of 40 km along the coast. This benefits private developers but golf courses provoke various environmental and social problems, including habitat loss, pollution of soils and aquifers, among others. Because the golf courses do not report their water demand, the annual water consumption was analyzed by indirect methods, using satellite imagery and geographic information systems. The obtained annual water demand of the 13 golf fields is 7.09 million m3, which is more than the whole water volume used for agriculture in this area. The findings suggest that the water consumption should be taken into account as an important environmental impact before the realization of new golf courses in Mexico.

COVID-19 resulted in considerable mental health burden in the Chinese general population and among health care workers at the beginning and peak of the pandemic. However, little is known about potentially vulnerable groups during the final stage of the lockdown. The aim of this survey study was to assess the mental health burden of different professions in China in order to find vulnerable groups, possible influencing factors, and successful ways of coping during the last 4 weeks of the lockdown in Hubei Province. A cross-sectional online survey asked participants about current residence, daily working hours, exposure to COVID-19 at work, and media preferences. We used a shortened version of the Depression, Anxiety and Stress Scale (DASS-21) to assess mental health. Further assessments included perceived stress (Simplified Chinese version of the 14-item Perceived Stress Scale), coping strategies for all participants, and specific stressors for health care workers. We followed the reporting guidelines of the STROBE (Strengthening the Reporting of Observational Studies in Epidemiology) statement for observational studies. The sample (N=687) consisted of 158 doctors, 221 nurses, 24 other medical staff, 43 students, 60 teachers/government staff, 135 economy staff, 26 workers/farmers, and 20 professions designated under the \"other\" category. We found increased depression (n=123, 17.9%), anxiety (n=208, 30.3%), and stress (n=94, 13.7%) in our sample. Professions that were vulnerable to depression were other medical staff and students. Doctors, nurses, and students were vulnerable to anxiety; and other medical staff, students, and economy staff were vulnerable to stress. Coping strategies were reduced to three factors: active, mental, and emotional. Being female and emotional coping were independently associated with depression, anxiety, or stress. Applying active coping strategies showed lower odds for anxiety while mental coping strategies showed lower odds for depression, anxiety, and stress. Age, being inside a lockdown area, exposure to COVID-19 at work, and having a high workload (8-12 hours per day) were not associated with depression, anxiety, or stress. WeChat was the preferred way of staying informed across all groups. By the end of the lockdown, a considerable part of the Chinese population showed increased levels of depression and anxiety. Students and other medical staff were the most affected, while economy staff were highly stressed. Doctors and nurses need support regarding potential anxiety disorders. Future work should focus on longitudinal results of the pandemic and develop targeted preventive measures.

The death toll of COVID-19 topped 170,000 in Europe by the end of May 2020. COVID-19 has caused an immense psychological burden on the population, especially among doctors and nurses who are faced with high infection risks and increased workload. The aim of this study was to compare the mental health of medical professionals with nonmedical professionals in different European countries during the COVID-19 pandemic. We hypothesized that medical professionals, particularly those exposed to COVID-19 at work, would have higher levels of depression, anxiety, and stress. We also aimed to determine their main stressors and most frequently used coping strategies during the crisis. A cross-sectional online survey was conducted during peak COVID-19 months in 8 European countries. The questionnaire included demographic data and inquired whether the participants were exposed to COVID-19 at work or not. Mental health was assessed via the Depression Anxiety Stress Scales32 (23.53)-21 (DASS-21). A 12-item checklist on preferred coping strategies and another 23-item questionnaire on major stressors were completed by medical professionals. The sample (N=609) consisted of 189 doctors, 165 nurses, and 255 nonmedical professionals. Participants from France and the United Kingdom reported experiencing severe/extremely severe depression, anxiety, and stress more often compared to those from the other countries. Nonmedical professionals had significantly higher scores for depression and anxiety. Among medical professionals, no significant link was reported between direct contact with patients with COVID-19 at work and anxiety, depression, or stress. \"Uncertainty about when the epidemic will be under control\" caused the most amount of stress for health care professionals while \"taking protective measures\" was the most frequently used coping strategy among all participants. COVID-19 poses a major challenge to the mental health of working professionals as a considerable proportion of our participants showed high values for depression, anxiety, and stress. Even though medical professionals exhibited less mental stress than nonmedical professionals, sufficient help should be offered to all occupational groups with an emphasis on effective coping strategies.

In contrast to almost all other invertebrate phyla that constructed biomineralized skeletons during the “Cambrian explosion” and maintained them during the entire fossil record, ascidian tunicates evolved this protective and stabilizing advantage only during the Permian, although soft-bodied representatives of this subphylum made their first appearance already in the early Cambrian. It remains enigmatic why these compound calcareous skeletons persisted only until the Late Triassic, subsequently followed by less-rigid internal skeletons from the Lower Jurassic onwards, which consist of scattered isolated spicules only. In addition to recently described aragonitic ascidian exoskeletons from the Permian and Triassic, new discoveries of similar, but colonial ascidian compound endoskeletons in the lower Carnian exhibit a short-living branch of this group, which moreover contain the first indubitable calcareous spicules. The latter are embedded in the solid endoskeleton, which is composed of polygonal aragonitic plates with smooth outer and zigzag lined inner boundaries. They consist of irregular, parallel (orthogonal), or fan-shaped (clinogonal) arrangements of acicular aragonite crystals. The following taxa are described as new: order Cassianomorpha new order with the family Cassianosomidae new family and the genus Toscanisoma new genus with the species T. multipartitum new species and T. triplicatum new species.