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  • Humans Are In The Middle Of “A Great Evolutionary Transition”, New Paper Claims

    Humans Are In The Middle Of “A Great Evolutionary Transition”, New Paper Claims

    There’s a problem with that “March of Progress” picture that’s so often used to illustrate our species’ development: it ends. Human evolution, the image implies, began in apehood and finishes here, with us. We’re done.

    It’s poetic, but it’s wrong. Evolution, famously, has no end goal – and there’s no reason to assume we’re already at the pinnacle of our species’ journey. In fact, as a new study from researchers at the University of Maine suggests, we might be right in the middle of a major evolutionary shift – and it’s one that’s totally different from anything we’ve seen before.

    “Human evolution seems to be changing gears,” Tim Waring, an associate professor of economics and sustainability at the University, said in a statement this week. “The importance of culture […] is accelerating.”

    The destination of life

    The story of life is one of small changes and major shifts. The growth from a single-celled organism to a multicellular one is, on paper, not that big – but philosophically, it’s a huge leap, paving the way for more complex life.

    We can see a similar sea-change in the late Jurassic period, with the emergence of eusocial species – that is, the kind of hyper-social groups we see in organisms like ants or termites. For such animals, the individual is less important than the colony – a kind of “superorganism” that has its own wants, needs, and intelligence. 

    Eusociality isn’t unknown in mammals – the naked mole-rat is a classic example of a milky critter that lives in colonies – but whether it can be applied to humans specifically is a question that’s been debated for decades now. 

    For Waring and coauthor Zachary Wood, the answer seems to be somewhere in the middle. Humans aren’t necessarily eusocial creatures, they argue – but we’re on our way: “In the very long term, we suggest that humans are evolving from individual genetic organisms to cultural groups which function as superorganisms, similar to ant colonies and beehives,” Waring explained back in 2021, after the publication of a paper on the same topic. 

    We don’t need to look far for an example of humans acting this way, he pointed out – we have a perfect example in the coronavirus pandemic, only a few years ago. In almost every nation, people reacted not as millions of individuals, but as a community – working as a “national immune system,” Waring said, to save society at whole from the disease.

    “The ‘society as organism’ metaphor is not so metaphorical after all,” he said. “This insight can help society better understand how individuals can fit into a well-organized and mutually beneficial system.”

    A changing species

    If humans are eusocial today – or tomorrow, if we believe the new paper – it’s only as the result of eons of development. Starting perhaps with the spread of agriculture, human societies have gradually grown stronger and more self-supporting, providing the very conditions that allow individuals within them to create the advancements that protect them.

    “Cultural organization makes groups more cooperative and effective,” explained Waring. “And larger, more capable groups adapt – via cultural change – more rapidly.” 

    “It’s a mutually reinforcing system,” he said. “And the data suggest it is accelerating.”

    The argument is obvious when viewed through a historical lens. Ten thousand years ago, a society would support itself by promoting the mass growth of crops, increasing individuals’ health and longevity – and, not coincidentally, making them more likely to stick around and perform some kind of community-supporting role. 

    Two thousand years ago, we had infrastructure like roads and aqueducts and public toilets. Two hundred years ago, societies were complex and advanced enough to create the first vaccines, improving life expectancy and saving millions of lives from diseases like smallpox. 

    And today, we have personalized gene editing technologies that can save newborns from genetic illnesses that could, in literally any other time period, be fatal within days. 

    Each of these advancements was the result of cultural evolution, not genetic – built on the foundations of all the invention and understanding that came before it. Who knows where we’ll be in a few decades?

    “Cultural evolution eats genetic evolution for breakfast,” said Wood, a researcher in ecology and environmental sciences at Maine. “It’s not even close.”

    A dispassionate process

    The role of culture in human evolution is impossible to overstate. Indeed, the pair point out, our societies are already sufficiently advanced to “preempt” genetic problems: more than three quarters of us wear vision-correcting eyeglasses, for example, and about one in three births in the US are via C-section. Both of these are solutions to problems that would, in the “natural” world, be at best disabling and at worst fatal.

    “When we learn useful skills, institutions or technologies from each other, we are inheriting adaptive cultural practices,” Waring explained. “On reviewing the evidence, we find that culture solves problems much more rapidly than genetic evolution. This suggests our species is in the middle of a great evolutionary transition.”

    “Ask yourself this: what matters more for your personal life outcomes, the genes you are born with, or the country where you live?” he continued. “Today, your well-being is determined less and less by your personal biology and more and more by the cultural systems that surround you – your community, your nation, your technologies.”

    It’s a strangely wholesome conclusion we’re forced to draw: that the story of humanity is one in which we come together to solve all our biggest problems. But of course, it comes with a flipside: “Evolution can create both good solutions and brutal outcomes,” pointed out Wood – and cultural evolution shouldn’t be confused with “progress” or superiority.

    “We are not suggesting that some societies, like those with more wealth or better technology, are morally ‘better’ than others,” Wood said. “We believe this [work] might help our whole species avoid the most brutal parts [of evolution].”

    Still, if their hypothesis is correct, it should be testable – and the pair intend on doing just that. They’re now developing mathematical and computer models of the process, and hope to soon be able to measure how fast humanity is switching from a species primarily governed by genetics to one ruled by cultural and societal change.

    “If cultural inheritance continues to dominate,” Waring said, “our fates as individuals, and the future of our species, may increasingly hinge on the strength and adaptability of our societies.”

    The study is published in the journal BioScience.

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  • Controlled Nutritional Status Score and Prognostic Nutritional Index f

    Controlled Nutritional Status Score and Prognostic Nutritional Index f

    Introduction

    Chronic subdural hematoma (CSDH) is a common condition where there is a collection of blood between the dura mater and the arachnoid membrane.1,2 Unlike acute subdural hematomas, which occur shortly after a traumatic brain injury, CSDHs have a slow onset and are often detected after manifestation of neurological symptoms, such as dizziness and tinnitus, memory loss, headache, nausea, and vomiting. The persistent hematoma compresses the brain tissue, leading to necrosis and neurological dysfunction. This can cause limitations in limb movement, cognitive impairment, speech confusion, and memory loss.3,4

    Surgical treatments for CSDH include puncture drainage, craniotomy for hematoma removal, burr-hole drainage, and endoscopic-assisted drilling drainage. Compared to craniotomy, drilling and drainage methods are often preferred due to their less invasive nature.5,6 A burr hole drainage is the most frequently used surgery for CSDH. Organized chronic subdural hematoma (OCSDH) is a rare form of chronic CSDH. While typical CSDHs are effectively treated with burr hole trephination and hematoma drainage, OCSH usually requires craniotomy and membranectomy, as it is not responsive to burr hole drainage.7–9 CSDH predominantly occurs in middle-aged and elderly patients, who are also at risk of malnutrition from neurological conditions like stroke, traumatic brain injuries, and intracranial tumors. Good nutrition is essential for healing, reducing complications, and improving outcomes after surgery. The patient’s nutritional status plays an important role in their overall surgical response and prognosis after surgery for CSDH.10–12

    The controlled nutritional status score (CONUT) is an indicator of malnutrition, which is calculated based on three key clinical indicators, 1) Serum albumin levels: Albumin is a protein produced by the liver, and low levels often indicate poor nutritional status, liver disease, or inflammation. It’s a key marker for assessing protein nutrition; 2) Total lymphocyte count (TLC): Lymphocytes are a type of white blood cell involved in the immune response. A low count can indicate malnutrition or weakened immunity affecting recovery and susceptibility to infection; 3) Total cholesterol levels: Cholesterol levels can provide insight into overall nutritional health. Low cholesterol levels are often associated with malnutrition or illness.13 CONUT is used as a prognostic marker in various medical conditions, including malignant tumors within specific elderly populations.14,15 The Prognostic Nutritional Index (PNI) is another widely used tool to assess nutritional status and predict outcomes in patients, particularly in relation to surgery, chronic diseases, and conditions where malnutrition can significantly affect prognosis. The PNI reflects nutritional and inflammatory status in patients undergoing gastrointestinal surgery; it is calculated based on serum albumin concentration and peripheral blood lymphocyte count. The PNI has demonstrated prognostic value in patients with stroke, head and neck tumors, and breast cancer.16–18 Both the CONUT and PNI eliminate the influence of subjective factors because they are based on objective measurements, providing an accurate reflection of the nutritional status of patients.

    CSDH is frequently seen in elderly patients, who are often at risk for nutritional deficiencies. The potential nutritional risk may significantly influence the clinical outcomes of elderly patients with CSDH.19 While CONUT and PNI have been studied in various medical conditions to predict prognosis, nutritional status, and outcomes, their role in predicting the prognosis or recurrence of CSDH has not been thoroughly explored. Therefore, this study aims to evaluate the nutritional risk in CSDH patients using CONUT and PNI and to predict the prognosis of CSDH following surgical intervention.

    Methods

    Study Design and Patients

    This retrospective study analyzes the clinical data from patients diagnosed with CSDH. These patients were admitted to the neurosurgery department of Affiliated Hospital of Chengde Medical University hospital between December 2017 and December 2022 and underwent surgical treatment. The inclusion criteria were as follows. 1) Patients aged 18 years or older; 2) Patients who had a clear diagnosis of CSDH by CT scan; 3) Patients who underwent burr-hole drainage as their initial surgical procedures; 4) Patients with complete clinical data; and 5) Patients who received necessary follow-up care after hospital discharge. The exclusion criteria were as follows: 1) Patients who had received transfusions of blood products, including whole blood, RBCs, plasma, and albumin before hospital admission; 2) Patients with concurrent infectious diseases; 3) Patients with chronic diseases, including cirrhosis of the liver, hyperlipidemia, and anemia; 4) Patients with a previous history of craniotomy; 5) Patients who had psychiatric and psychological disorders concurrently; and 6) Patients with incomplete clinical data or who failed to follow-up.

    Patients identified as at risk of malnutrition received individualized nutritional guidance. Personalized nutrition treatment plans were developed by a registered dietitian, incorporating high-protein dietary recommendations and, when indicated, enteral nutrition support. Nutritional interventions were tailored based on the patient’s clinical condition, nutritional risk score, and tolerance to oral intake.

    This study was conducted in accordance with the ethical principles of the Declaration of Helsinki and its later amendments. It was approved by the Ethics Committee of the Affiliated Hospital of Chengde Medical University. The requirement for informed consent was waived due to the retrospective nature of the data analysis. All patient data were anonymized and handled with strict confidentiality in compliance with institutional and data protection guidelines to ensure the privacy and rights of all individuals involved.

    Data Collection

    Data was collected regarding the patient’s age, sex, height, weight, smoking history, drinking history, and medical history, including any illnesses, such as hypertension and diabetes. Information on the use of lipid-lowering, anticoagulant, and antiplatelet medications was also gathered. Additionally, preoperative laboratory values were retrieved, including serum albumin (ALB), hemoglobin (HB), blood glucose levels, peripheral lymphocyte counts, neutrophil counts, total cholesterol, triglyceride levels, percentage of peripheral mononuclear cells, and fibrinogen levels. Details about the hematoma were also documented, including its location, volume, density, width, midline shift, subdural space, and the amount of intracranial fluid and pneumoperitoneum present before discharge. Intracranial fluid volume refers to the volume of intracranial fluid (eg, residual hematoma, cerebrospinal fluid, or other fluid collections) present in the brain after the surgical procedure to evacuate the CSDH before the hospital discharge.

    Prognostic Score

    Patients were assessed using the modified Rankin scale (mRS) at hospital discharge, and their prognosis was categorized based on their mRS scores. The classifications were as follows. 0: completely asymptomatic; 1: symptomatic but not functionally impaired; 2: mildly handicapped, able to care for themselves but with some limitations; 3: moderately handicapped, unable to fully care for themselves but able to walk independently; 4: severely handicapped and unable to walk independently; 5: bedridden; and 6: diseased.20 Based on the mRS at discharge, patients were divided into two groups: a poor prognosis group (mRS of ≥3) and a good prognosis group (mRS of <3).

    CONUT Calculation

    The CONUT was determined based on three parameters: preoperative ALB (g/L), peripheral blood lymphocyte count (×109 cells/L), and serum total cholesterol value (mg/dl), and the scoring criteria for each parameter were as follows. 1) Peripheral blood lymphocyte count (×109 cells/L) was divided into four levels, ≥1.60×109 cells/L, (1.20–1.59)×109 cells/L, (0.80–1.19)×109 cells/L, and <0.80×109 cells/L. ≥1.60×109 cells/L, (1.20–1.59)×109/L, (0.80–1.19)×109/L, and <0.80×109/L were scored 0, 1, 2, and 3 points, respectively. 2) Serum albumin levels were grouped into ≥35.0 g/L, 30.0–34.9 g/L, 25.0–29.9 g/L, and <25.0 g/L, and were scored as 0, 2, 4, and 6 respectively. 3) The serum total cholesterol levels were categorized into four groups, >4.68 mmol/L, 3.64–4. 68 mmol/L, 2.6–3. 63 mmol/L, and < 2.6 mmol/ L, with scores of 0, 1, 2, and 3, respectively. To calculate the CONUT, the points from the three parameters were added together. The resulting score was categorized as follows: 0–1: Normal; 2–4: Slightly Abnormal; 5–8: Moderately Abnormal; and 9 and above: Severely Abnormal.21 A CONUT of ≥2 indicated nutritional risk, while a score of <2 indicated no nutritional risk.

    PNI Calculation

    PNI was calculated, using the formula, PNI=ALB (g/L)+5×lymphocyte count (109/L), with reference to the criteria developed by Onodera et al, PNI of ≥45 was considered no nutritional risk, and PNI of <45 was considered a nutritional risk.22

    Statistical Analysis

    Statistical analysis was conducted using SPSS version 29.0. Data were expressed as mean ± standard deviation. A t-test was utilized to determine differences between the poor prognosis and good prognosis groups when the data was normally distributed. The Mann–Whitney U-test was applied to see the differences between the groups when the data was non-normally distributed. Count data represented as percentages (%) were analyzed using the chi-square (χ²) test. In cases where the data exhibited a hierarchical distribution, the rank-sum test was applied to assess differences between the groups. Receiver operating characteristic (ROC) curves were generated to evaluate the predictive value of CONUT and PNI on the postoperative prognosis of patients with chronic CSDH. Additionally, univariate and multivariate logistic regression analyses were performed to identify risk factors associated with CSDH. A p-value of <0.05 was considered statistically significant.

    Results

    Patient Characteristics

    This study examined 205 patients who underwent surgery for CSDH (Table 1). Among these patients, 17 (8.3%) had a poor prognosis. The mean age of the group with a poor prognosis was significantly higher (72.82 ± 8.85 years, P<0.05) compared to the group with a good prognosis, whose mean age was 65.49 ± 12.82 years. In the poor prognosis group, there were 11 cases (64.7%) identified with nutritional risk (PNI<45), and 16 cases (94.1%) had a CONUT of ≥2. Conversely, in the good prognosis group, 36 cases (19.1%) had nutritional risk (PNI<45), and 62 cases (33%) had a CONUT of ≥2. The PNI and CONUT scores between the two groups showed significant differences (P < 0.05).

    Table 1 Demographic and Clinical Characteristics of Patients

    Laboratory Indicators

    In comparison to the group with a good prognosis, the poor prognosis group showed decreased levels of albumin (ALB), hemoglobin (HB), and triglycerides, while fibrinogen levels were elevated (P<0.05). However, there were no statistically significant differences observed in blood glucose levels, neutrophil count, platelet count, or lymphocyte count (Table 2).

    Table 2 Laboratory Indicators

    Imaging Characteristics

    All patients underwent cranial CT scans to confirm a diagnosis of CSDH (Table 3). There was no statistically significant difference between the two groups regarding hemorrhage location, hematoma width, midline shift, pre-discharge subdural space, hematoma volume, and pre-discharge intracranial pneumatization. However, there was a statistically significant difference in hematoma density and pre-discharge intracranial fluid volume between the two groups (P<0.05).

    Table 3 Imaging Characteristics

    To further illustrate the changes in hematoma before and after surgery, Figure 1 presents representative cranial CT images of patients with left-sided, right-sided, and bilateral CSDH. The images show the hematoma appearance in the preoperative, postoperative, and re-examination phases. In each row, the progressive reduction and eventual resolution of the subdural hematoma following burr-hole drainage can be observed. This figure demonstrates the typical radiological evolution of CSDH in different locations after surgical intervention.

    Figure 1 Representative cranial CT images showing radiological evolution of chronic subdural hematoma (CSDH) before and after surgical intervention. Each row presents images from a patient with left-sided, right-sided, or bilateral CSDH, respectively. Columns correspond to three time points: preoperative, postoperative, and re-examination phases. The images illustrate the typical reduction and resolution of subdural hematoma following burr-hole drainage across different hematoma locations. These serial CT scans highlight the radiological changes and treatment response at each stage of management.

    Predictability of CONUT and PNI for the Prognosis of CSDH

    The ROC curve analysis indicated that the area under the curve (AUC) for CONUT in predicting the prognosis of CSDH was 0.719 (95% CI: 0.5867–0.8523, P=0.002). The optimal cutoff value for CONUT was determined to be 3.5, which resulted in a sensitivity of 84.0%, a specificity of 47.1%, and a false-positive rate of 52.9%. For the PNI, the AUC was 0.803 (95% CI: 0.7031–0.9042, P<0.001). The optimal PNI value was found to be 44.69, with a sensitivity of 81.0%, a specificity of 64.5%, and a false-positive rate of 35.3%. When combining both CONUT and PNI, the AUC increased to 0.805 (95% CI: 0.7039–0.9059, P<0.001). This combination yielded a sensitivity of 92.5%, a specificity of 76.5%, and a false-positive rate of 23.5%. In summary, while CONUT demonstrated higher sensitivity and a greater false-positive rate compared to PNI, PNI exhibited better specificity. The combined use of CONUT and PNI yielded the most favorable results, with the highest sensitivity and specificity as well as the lowest false-positive rate (Figure 2 and Table 4).

    Table 4 Predictive Value of CONUT and PNI for the Prognosis of CSDH

    Figure 2 Receiver operating characteristic (ROC) curves for CONUT, PNI, and the combined CONUT+PNI in predicting poor prognosis of chronic subdural hematoma (CSDH). The ROC curves display the diagnostic performance of the Controlling Nutritional Status (CONUT) score (solid line), Prognostic Nutritional Index (PNI) (dashed line), and the combination of CONUT and PNI (dotted line). The curves plot sensitivity against 1-specificity for each index. The area under the curve (AUC) values for each predictor are shown, demonstrating the comparative prognostic accuracy of these nutritional indices for postoperative outcomes in CSDH patients.

    Risk Factors Predicting Poor Prognosis of CSDH After Surgical Intervention

    The univariate logistic regression was conducted to identify factors predicting poor prognosis in CSDH following burr-hole drainage. In this analysis, poor prognosis was treated as the dependent variable, while various factors from general clinical data, laboratory tests, and CT results were considered independent variables (Table 5). The findings revealed that age, albumin level (ALB), PNI, CONUT score, total cholesterol (TC), and the amount of intracranial fluid present before discharge were significant risk factors for poor prognosis in patients undergoing burr-hole drainage for CSDH (P<0.05). Multivariate analyses indicated that CONUT (OR=1.485, 95% CI: 1.096–2.011) and PNI (OR=0.850, 95% CI: 0.763–0.947) were independent risk factors for poor prognosis of CSDH following surgical intervention, after adjusting for age, hypertension, and pre-discharge intracranial fluid volume (Tables 6 and 7).

    Table 5 Univariate Binary Logistic Regression Analysis for a Poor Prognosis of CSDH

    Table 6 The Multivariate Logistic Regression Analysis with CONUT

    Table 7 The Multivariate Logistic Regression Analysis with PNI

    Discussion

    In the study, it was found that 64.7% of patients exhibited nutritional risk based on the PNI, while 94.1% of patients in the poor prognosis group had abnormal results when assessed by the CONUT. In contrast, among patients in the good prognosis group, only 19.1% showed nutritional risk based on PNI and 33% had abnormal CONUT.

    The incidence of CSDH is rising among the elderly population, largely due to their frequent use of anticoagulants and antiplatelet medications.23,24 Factors such as abnormal coagulation, neovascularization, and inflammatory responses may contribute to the onset and progression of CSDH. This condition can lead to neurological disorders due to increased intracranial pressure, epilepsy, stroke, hemiparesis, and other abnormal neurological responses. Surgical interventions, such as drilling and draining, are commonly employed to remove the hematoma, alleviate pressure on the brain, and decrease intracranial pressure. However, the recurrence following these procedures remains high, often resulting in a poor prognosis. Elderly patients with CSDH also face a heightened risk of nutritional deficits. Nutritional risk has been observed in various neurological disorders, including craniocerebral injuries, subarachnoid hemorrhage, and gliomas, and the patient’s nutritional status has been correlated with their clinical outcomes.25–27 The PNI and CONUT are both scoring systems widely used to assess the nutritional status of patients, particularly with their prognosis and potential outcomes in various clinical settings, including surgical interventions and chronic diseases. This study has identified a relationship between preoperative nutritional status, as assessed by the CONUT and PNI, and postoperative prognosis in patients with CSDH.

    In addition to the nutritional indices, our study also provides representative cranial CT imaging findings to illustrate the typical radiological evolution of CSDH after surgical intervention. The serial CT scans from selected patients with left-sided, right-sided, and bilateral CSDH demonstrate the progressive reduction and eventual resolution of subdural hematoma following burr-hole drainage. These images highlight the dynamic changes in hematoma volume and density at different stages: preoperative, postoperative, and during follow-up.28 Including these imaging examples offers a visual reference for understanding the typical course of CSDH after treatment and supports the clinical findings of our cohort.

    The CONUT, derived from preoperative albumin (ALB), peripheral blood lymphocyte count, and serum total cholesterol (TC), was closely linked to the prognosis of various malignancies.29,30 Serum ALB levels indicate the body’s nutritional status, while pro-inflammatory cytokines inhibit albumin synthesis, which correlates with tumor necrosis.31 Previous studies have demonstrated a strong relationship between serum total cholesterol levels and patient survival after surgical treatment for renal cell carcinoma.32

    The total lymphocyte count reflects the immune status of the body, and a lower lymphocyte count has been associated with poorer prognoses for colon tumors.33 In CSDH, decreased levels of ALB and lymphocyte counts were associated with a higher risk of complications.34 Additionally, factors such as age, comorbidities, and the use of anticoagulant medications were linked to the recurrence of CSDH.35 In our study, we found that the poor prognosis group had significantly higher ages and greater amounts of intracranial effusion before hospital discharge, while their serum ALB, triglyceride levels, and hemoglobin (HB) were significantly lower. According to the CONUT analysis, 94.1% of patients in the poor prognosis group were at nutritional risk, compared to 67% in the good prognosis group.

    Recent studies have emphasized the prognostic value of nutritional indices such as CONUT and PNI in various clinical settings, including surgical and neurological diseases. In our study, the ROC analysis demonstrated that both CONUT and PNI are valuable predictors of poor prognosis in patients with CSDH following surgery, with the combined use of both scores further enhancing predictive accuracy. This finding aligns with previous research in other neurological and oncological populations, where the CONUT score has been shown to predict postoperative complications and mortality.14,27,28 For example, Liu et al14, and López Espuela et al21, both reported that higher CONUT scores were independently associated with increased in-hospital mortality and worse outcomes after stroke or traumatic brain injury, highlighting the broader applicability of this tool.

    Similarly, our observation that the PNI is associated with postoperative prognosis is consistent with studies in patients undergoing gastrointestinal and hepatobiliary surgery, as well as those with malignancies and cerebrovascular diseases.16,17,22,31,36,37 Tsukagoshi et al22 and Mohri et al31 found that lower PNI scores correlated with higher rates of postoperative complications and poorer long-term survival, emphasizing the importance of preoperative nutritional assessment.

    Notably, our results suggest that the combined use of CONUT and PNI provides better discrimination for poor prognosis than either index alone. While previous studies have typically evaluated these indices separately, our data support the approach advocated by Kanemoto et al38 who suggested that integrating multiple nutritional markers may yield a more robust risk stratification model for surgical patients. Moreover, as in our cohort, several studies have found that nutritional risk, as reflected by low PNI or high CONUT scores, is particularly prevalent among elderly and neurologically compromised populations, further underscoring the need for routine nutritional screening.10,14,18,25 Despite these promising findings, it is important to acknowledge that, as reported in the literature, nutritional indices may be influenced by unmeasured confounders such as perioperative nutritional interventions or the recurrence of hematoma.38,39 Future prospective studies should therefore incorporate standardized nutrition management protocols to clarify the causal relationship between nutritional status and clinical outcomes.

    This study has several limitations. It is a single-center retrospective analysis with a small sample size. Additionally, the CONUT and PNI were calculated solely based on laboratory results, without any subjective evaluation of the patients. Therefore, future studies should involve a larger sample size and a multicenter design to validate these findings. A key limitation is the lack of preoperative assessment of ADL and frailty. As these are important confounding factors that may influence both nutritional status and clinical outcomes, their absence limits the interpretation of CONUT and PNI as independent predictors. Due to the retrospective design and incomplete data, we were unable to supplement this information in the current study. Future research should incorporate standardized frailty and functional assessments to better clarify their relationship with nutritional status and prognosis. Furthermore, our study did not systematically document whether any nutritional interventions were provided to patients during hospitalization. The potential effect of in-hospital nutritional support on patient outcomes could not be evaluated in this analysis. Future prospective studies should collect detailed data on perioperative nutritional interventions to more accurately assess their impact on prognosis.

    Conclusion

    This study evaluated the nutritional status of patients with CSDH using the PNI and the CONUT. It also analyzed the relationship between these scores and the poor prognosis of CSDH following surgical intervention. Both PNI and CONUT demonstrated high sensitivity in predicting patient outcomes. However, the highest sensitivity and specificity were achieved when the two scores were combined, suggesting that using both PNI and CONUT together has significant value in forecasting the prognosis of CSDH. Thus, their clinical usefulness is enhanced when used in combination. These findings highlight the potential utility of PNI and CONUT as practical tools for preoperative risk stratification in elderly patients with CSDH, and future prospective, multicenter studies incorporating standardized frailty assessments are warranted to validate and expand upon these results.

    Abbreviations

    CSDH, Chronic subdural hematoma; CONUT, Controlling nutritional status score; PNI, Prognostic nutritional index; ROC, Receiver operating characteristic curve; ALB, Albumin.

    Acknowledgment

    We acknowledge the funding from Medical Science Research Project of Hebei (NO: 20242041) and the valuable contributions of the neuroradiologist (Jinhai Sai) for their assistance with image analysis.

    Disclosure

    The authors report no conflicts of interest in this work.

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    20. Broderick JP, Adeoye O, Elm J. Evolution of the modified Rankin scale and its use in future stroke trials. Stroke. 2017;48(7):2007–2012. doi:10.1161/STROKEAHA.117.017866

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    22. Tsukagoshi M, Araki K, Igarashi T, et al. Lower geriatric nutritional risk index and prognostic nutritional index predict postoperative prognosis in patients with hepatocellular carcinoma. Nutrients. 2024;16(7):940. doi:10.3390/nu16070940

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  • AirAsia flight attendants’ TikTok dance divides opinions over safety and marketing

    AirAsia flight attendants’ TikTok dance divides opinions over safety and marketing

    Female cabin crew members of AirAsia, a Malaysian low-cost carrier, have ignited mixed reactions online with their in-flight dance performance.

    While some critics argue the routine prioritizes marketing over passenger safety and service, others praise it as a creative branding effort.

    A TikTok video lasting about one minute shows AirAsia female cabin crew members dancing in the aisle during a flight on the Bangkok Don Mueang–Phuket route. The clip has garnered over 900,000 views and more than 40,000 likes, sparking discussions across social media.

    The crew performed in tight-fitting uniforms exposing midriffs, and some tattoos were visible. One performer, Aimma, is a member of Véra, a female idol group launched by AirAsia in March.

    The dance was set to their debut song, Tick-Tock, which is themed around on-time departures and intended to strengthen the airline’s brand image.

    The performance reportedly took place after service completion, with participation from other crew members.

    AirAsia’s official account commented on the video with the song’s name, while Aimma personally liked the post.

    However, the airline has not issued an official statement regarding the performance.

    Reactions were divided. Critics wrote, “The primary duty of cabin crew is safety and service,” “This could disrupt passengers’ rest,” and “Unthinkable in regions that prioritize safety,” noting possible discomfort for families or children.

    Supporters responded positively, calling it “a unique in-flight experience” and “a fresh approach to airline marketing.”

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  • Where did all the Brisbane festivals go? Down the road to the Gold Coast

    Where did all the Brisbane festivals go? Down the road to the Gold Coast

    While the move is frustrating for Brisbane music fans, the city isn’t exactly flush with other options. The RNA can hold about 22,000 people, while other outdoor venues, such as The Sporting Fields at Victoria Park, don’t have the capacity to accommodate such a large crowd, or the numerous stages that Laneway is known for.

    The organisers said in a TikTok comment that Laneway’s new home, the Southport Sharks, “will be able to fit just as many people as Brisbane could”, on the venue’s AFL fields and nearby green spaces.

    Music lovers attend Laneway Festival last year. Credit: Daniel Boud Crowd

    In my experience, the RNA was by far the most convenient location for Brisbanites – just a 15-minute walk from Fortitude Valley station, or an Uber to Gregory Terrace.

    The RNA experience always felt seamless, unlike the nightmare that is Doug Jennings Park at Main Beach, where I attended the Souled Out Festival in 2024.

    After being confronted with what felt like endless queues for coaches after the headline set, my friend and I decided to walk to a main road to find a tram. Trekking down Seaworld Drive with blistered feet and a dwindling game of “I Spy” to keep us entertained, I vowed to never subject myself to that experience again.

    But it wasn’t long before my resolve dissolved and I bought tickets to Spilt Milk for this coming December to endure the entire ordeal all over again. Sometimes the headliners outweigh the blisters (hello Kendrick Lamar and Doechii).

    While Laneway 2026 isn’t being taken hostage by Doug Jennings Park, its move away from the familiar and convenient RNA Showgrounds fills me with apprehension.

    Yes, accommodation options abound on the Gold Coast, but there’s something so comforting about ending the night in my own bed.

    Even though I love a festival, I’m not willing to abandon my entire routine for one night of fun – I’m not 18 any more.

    All other Laneway locations are in capital cities, so it feels embarrassing that Brisbane has slipped off the radar. Will RNB festival Fridayz Live, punk festival Good Things, and New Year’s rave Wildlands all decamp to our southern neighbours too?

    As Brisbane prepares for the 2032 Olympics, let’s hope not.

    Start the day with a summary of the day’s most important and interesting stories, analysis and insights. Sign up for our Morning Edition newsletter.

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  • Neeraj Chopra qualifies for World Athletics Championships 2025 javelin final

    Neeraj Chopra qualifies for World Athletics Championships 2025 javelin final

    One throw, that was all Neeraj Chopra needed to ensure that he would be defending his men’s javelin crown at the World Athletics Championships 2025 finals in Tokyo on Thursday.

    Neeraj Chopra, a two-time Olympic medallist, comfortably booked his place in the medal round with an 84.85m throw in Group A of the qualifiers at the Tokyo National Stadium on Wednesday. The automatic qualification mark was set at 84.50m.

    The 27-year-old Indian athlete, currently world No. 2, began the proceedings in his group and breached the mark with his very first throw.

    Neeraj Chopra’s personal best is 90.23m – also the Indian national record – achieved at the Doha Diamond League earlier this year.

    “It feels great to qualify for the final in the first round. Now, I need to stay healthy and focus. I think I am ready. I need to concentrate and give my best,” Neeraj Chopra said after securing his spot in the 12-man final.

    Germany’s Julian Weber, the top-ranked men’s javelin thrower in the world currently, fell short with his first throw but came good with a second haul of 87.21m.

    Poland’s Dawid Wegner was the only other athlete from Group A who earned a direct qualification with a new personal best of 85.67m.

    India’s Sachin Yadav finished sixth in Group A with a commendable 83.67m throw but will now need to wait for Group B results to know if he will qualify for the medal round. Tokyo 2020 silver medallist Jakub Vadlejch was fourth with 84.11m and Olympic medallist Keshorn Walcott finished fifth in the group with an 83.93m throw.

    Pakistan’s Arshad Nadeem, the reigning Olympic champion, will start his campaign in the qualifiers Group B later today. India’s Rohit Yadav and Yashvir Singh are also in the group.

    Overall, 12 athletes out of 37 will qualify for the final. Barring those who breach the automatic qualification mark, the next best throwers will make the cut until the quota is filled.

    At the last edition of the World Championships in Budapest two years ago, Neeraj Chopra created history by becoming India’s first world champion in athletics with a throw of 88.17m. Arshad Nadeem took silver with 87.82m.

    However, the standing was flipped at the Paris 2024 Olympics last year.

    Another Neeraj Chopra vs Arshad Nadeem could be on the cards in Tokyo on Thursday.

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  • FIF – Go Digital in WB – Addiko Bank Sarajevo

    Understanding transition

    Further information regarding the EBRD’s approach to measuring transition impact is available here.

    Business opportunities

    For business opportunities or procurement, contact the client company.

    For business opportunities with the EBRD (not related to procurement) contact:

    Tel: +44 20 7338 7168

    Email: projectenquiries@ebrd.com

    For state-sector projects, visit EBRD Procurement:

    Tel: +44 20 7338 6794

    Email: procurement@ebrd.com

    General enquiries

    Specific enquiries can be made using the EBRD Enquiries form.

    Environmental and Social Policy (ESP)

    The ESP and its associated Environmental and Social Requirements (ESRs) set out the ways in which the EBRD implements its commitment to promoting “environmentally sound and sustainable development”.  The ESP and the ESRs include specific provisions for clients to comply with the applicable requirements of national laws on public information and consultation, and to establish a grievance mechanism to receive and facilitate resolution of stakeholders’ concerns and grievances, in particular, about the environmental and social (E&S) performance of the client and the project. Proportionate to the nature and scale of a project’s environmental and social risks and impacts, the EBRD also requires its clients to disclose information, as appropriate, about the risks and impacts of projects or to undertake meaningful consultation with stakeholders and consider and respond to their feedback.

    More information on the EBRD’s practices in this regard is set out in the ESP.

    Integrity and compliance

    The EBRD’s Office of the Chief Compliance Officer (OCCO) promotes good governance and ensures that the highest standards of integrity are applied to all of the Bank’s activities in accordance with international best practice. Integrity due diligence is conducted on all Bank clients to ensure that projects do not present unacceptable integrity or reputational risks to the Bank. The EBRD believes that identifying and resolving issues in the project assessment and approval stages is the most effective means of ensuring the integrity of Bank transactions. OCCO plays a key role in these protective efforts andhelps to monitor integrity risks in projects post-investment.

    OCCO is further responsible for investigating allegations of fraud, corruption and misconduct in EBRD-financed projects. Anyone, either within or outside the Bank, who suspects fraud or corruption should submit a written report to the Chief Compliance Officer by email to compliance@ebrd.com. OCCO will follow-up all matters reported. It will review all matters reported. Reports can be made in any language of the Bank or of the Bank’s countries of operation. The information provided must be made in good faith.

    Access to Information Policy (AIP)

    The AIP, which entered into force on 1 January 2025, sets out how the EBRD discloses information and consults with its stakeholders to promote better awareness and understanding of its strategies, policies and operations. Please visit the Access to Information Policy page to find out what information is available from the EBRD website.

    Specific requests for information can be made using the EBRD enquiries form.

    Independent Project Accountability Mechanism (IPAM)

    If efforts to address environmental, social or public disclosure concerns with the Client or the Bank are unsuccessful (for example, through the client’s project-level grievance mechanism or through direct engagement with Bank management), individuals and organisations may seek to address their concerns through the EBRD’s Independent Project Accountability Mechanism (IPAM).

    IPAM independently reviews project issues that are believed to have caused (or to be likely to cause) harm. The purpose of the mechanism is: to support dialogue between project stakeholders to resolve environmental, social and public disclosure issues; to determine whether the Bank has complied with its Environmental and Social Policy or the project-specific provisions of its Access to Information Policy; and where applicable, to address any existing non-compliance with these policies, while preventing future non-compliance by the Bank.

    Please visit the Independent Project Accountability Mechanism webpage to find out more about IPAM and its mandate and how to submit a Request for review. Alternatively, contact IPAM by email at ipam@ebrd.com for guidance and more information on IPAM and how to submit a request.

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  • Catastrophic disruption of asteroid 2023 CX1 and implications for planetary defence

    Catastrophic disruption of asteroid 2023 CX1 and implications for planetary defence

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  • South Africa’s Gian-Quen Isaacs draws strength from Chad le Clos on road to Milano Cortina 2026

    South Africa’s Gian-Quen Isaacs draws strength from Chad le Clos on road to Milano Cortina 2026

    Lessons from Chad le Clos

    The hours on the ice have paid dividends in recent years as she is exposed to more international competitions.

    She took a step closer to the big leagues when she competed at the Four Continents Championships in the Republic of Korea. Isaacs has also spent time at the Ice Lab in Bergamo, Italy, one of Europe’s premier training hubs for the sport, working under coach and choreographer Ondrej Hotarek.

    As she navigates the pressures of competing on the global stage, Isaacs has found inspiration and words of wisdom from South Africa’s second most decorated Olympian, Chad le Clos.

    Le Clos’ incredible upset victory over Michael Phelps in the 200m butterfly at London 2012 counts as one of her earliest memories of the Olympic Games.

    When Isaacs got to meet her idol earlier in 2025, she asked him for some tips on making it on the global stage.

    “So, I met him again in January, and he’s so cool, and he had a lot of good tips when it came to being an athlete at this stage of my career,” she said.

    “I was saying that it was really difficult as a South African to go out on that stage and do well, especially with a lot of pressure.

    “And I still remember he told me that I should, instead of thinking of it as pressure, I should really just perform. I should go out there and be like, ‘Okay, you are all here to see me. And he was like, ‘Go in with the idea of ‘Okay, I’m just here and I’m performing, and I am going to make everyone watch me and I’m going to be the best. So yeah, it was really good advice.”

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  • Volcanic sulfur on Mars could have been helpful for life

    Volcanic sulfur on Mars could have been helpful for life

    View larger. | NASA’s Curiosity rover found these pure sulfur crystals on May 30, 2024, after it drove over and broke open a rock. Now, a new study from researchers at the University of Texas at Austin shows that reduced forms of volcanic sulfur on Mars could have kept the atmosphere warm enough for liquid water and possibly life. Image via NASA.
    • Was Mars ever warm enough to support life? Scientists still don’t know exactly what the climate was like on Mars billions of years ago. But there are clues.
    • Reduced forms of sulfur from active volcanoes could have kept the planet warm by creating a greenhouse effect. The findings are based on new atmospheric simulations and studies of Martian meteorites.
    • These other forms of sulfur would have dominated the greenhouse process, rather than sulfur dioxide or carbon dioxide alone, as previously hypothesized.

    Volcanic sulfur on Mars

    Was Mars ever warm enough to support life? We know there was once abundant water on the surface. But scientists still don’t know exactly what the climate was like billions of years ago. Researchers at the University of Texas at Austin said on September 11, 2025, that volcanic activity likely helped keep the atmosphere warm enough for life to exist. They said sulfur gases released from volcanoes could have created the greenhouse effect needed to make the planet hospitable for life. The researchers ran over 40 computer simulations to study the possible atmosphere of early Mars.

    Unlike previous models that suggested primarily sulfur dioxide or carbon dioxide, the new study shows that other reduced forms of sulfur might have been the dominant gases involved instead. Reduced sulfur refers to sulfur atoms in a negative oxidation state, forming compounds like hydrogen sulfide (H2S) and thiols (mercaptans).

    The researchers published their peer-reviewed findings in Science Advances on September 3, 2025.

    Volcanic emissions of reactive sulfur gases on early Mars may have contributed to a greenhouse effect, potentially creating conditions favorable for liquid water and microbial life. doi.org/g93fsc

    — Science X / Phys.org (@sciencex.bsky.social) 2025-09-11T15:19:15-04:00

    Simulating Mars’ early atmosphere

    To try to determine how Mars’ early atmosphere could have been warm enough for life, the researchers ran over 40 computer simulations. The simulations used various temperatures and concentrations of gases and chemistry based on data from Martian meteorites. By doing so, the researchers could estimate how much carbon, nitrogen and sulfide gases were present billions of years ago.

    Previously, scientists had considered sulfur dioxide or carbon dioxide to be the most likely gas to help create a greenhouse effect. The new results, however, suggested something a bit different: reduced and highly reactive forms of sulfur. This could include sodium sulfide (H2S), disulfur (S2) or sulfur hexafluoride (SF6). Sulfur hexafluoride, in particular, is an extremely potent greenhouse gas.

    As lead author Lucia Bellino at the University of Texas at Austin explained, this could have resulted in a climate able to maintain liquid water and even support some forms of life:

    The presence of reduced sulfur may have induced a hazy environment which led to the formation of greenhouse gases, such as SF6 [sulfur hexafluoride], that trap heat and liquid water. The degassed sulfur species and redox conditions are also found in hydrothermal systems on Earth that sustain diverse microbial life.

    Huge, sprawling volcano on reddish planet. A bluish haze is along the limb of the planet, with black space in the background.
    View larger. | Perspective view from Mars Express of Olympus Mons on Mars, the largest volcano in the solar system. This and many other ancient volcanoes could have helped maintain a habitable environment on Mars billions of years ago. Image via ESA/ DLR/ FU Berlin/ J. Cowart (CC BY-SA 3.0 IGO).

    Sulfur kept changing forms

    In addition, the study revealed that the sulfur might not have stayed the same. Instead, it kept changing forms. The meteorites contain reduced sulfur. But most of the sulfur that has been seen directly on the Martian surface is chemically bonded to oxygen. The difference suggests that this kind of sulfur cycling was common on early Mars. Bellino said:

    This indicates that sulfur cycling – the transition of sulfur to different forms – may have been a dominant process occurring on early Mars.

    Smiling woman with long hair and trees in the background behind her.
    Lucia Bellino at the University of Texas at Austin is the lead author of the new study about sulfur on Mars and how it might have provided habitable conditions. Image via Lucia Bellino.

    Curiosity rover finds pure sulfur crystals

    There’s another interesting twist to sulfur on Mars, too. In 2024, NASA’s Curiosity rover drove over a small rock, crushing it in the process. And the broken pieces revealed something unexpected. The rock was filled with crystals of elemental sulfur. Unlike other sulfur seen previously on the surface, this was pure sulfur, not bound to oxygen in sulfate. Co-author Chenguang Sun at the University of Texas at Austin said:

    We were very excited to see the news from NASA and a large outcrop of elemental sulfur. One of the key takeaways from our research is that as S2 [disulfur] was emitted, it would precipitate as elemental sulfur. When we started working on this project, there were no such known observations.

    Next, the team plans to use the same simulations to study the possible sources of water on early Mars, including volcanoes. In addition, they will investigate whether microbes could have used reduced sulfur as a food source.

    Bottom line: Did early Mars support life? A new study shows how volcanic sulfur on Mars could have kept the planet warm and wet enough to be habitable billions of years ago.

    Source: Volcanic emission of reduced sulfur species shaped the climate of early Mars

    Via The University of Texas at Austin

    Read more: NASA announces Mars rock as a potential biosignature

    Read more: Mars’ interior might contain remnants of baby planets

    Paul Scott Anderson

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    About the Author:

    Paul Scott Anderson has had a passion for space exploration that began when he was a child when he watched Carl Sagan’s Cosmos. He studied English, writing, art and computer/publication design in high school and college. He later started his blog The Meridiani Journal in 2005, which was later renamed Planetaria. He also later started the blog Fermi Paradoxica, about the search for life elsewhere in the universe.

    While interested in all aspects of space exploration, his primary passion is planetary science and SETI. In 2011, he started writing about space on a freelance basis with Universe Today. He has also written for SpaceFlight Insider and AmericaSpace and has also been published in The Mars Quarterly. He also did some supplementary writing for the iOS app Exoplanet.

    He has been writing for EarthSky since 2018, and also assists with proofing and social media.

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  • Kate Middleton & King Charles’ Sweet Bond Was on Display at Royal Funeral

    Kate Middleton & King Charles’ Sweet Bond Was on Display at Royal Funeral

    Kate Middleton and King Charles have always shared a warm relationship, which was evident in their recent gathering. The royals came together to pay respect to the funeral of Katharine, the Duchess of Kent, on September 16. While leaving the Westminster Cathedral, the Princess of Wales’ gesture as she bid farewell to her father-in-law has been captured in photos.

    Kate Middleton’s sweet gesture towards father-in-law King Charles was captured in a photo

    Kate Middleton’s warm gesture towards King Charles in new photos appeared to be sweet. The two met when the royal family gathered at Westminster Cathedral on Tuesday at the funeral of the Duchess of Kent, Katharine. At the age of 92, Katharine passed away on September 4. As her coffin was shifted to a hearse after the Requiem Mass service, the family members were reportedly standing on the steps. It was time to say goodbye to the attendees.

    When the 76-year-old king was about to go towards his car, his daughter-in-law warmly bid him farewell. She planted a kiss on the monarch’s cheeks, followed by a quick curtsy. While placing her hand on his shoulder, she looked at her father-in-law with warm eyes, showcasing their bond. He seemed to have responded to the gesture in the same way.

    According to PEOPLE, their interaction gave a glimpse into the sweet relationship the two share. Last year, royal biographer Sally Bedell Smith told the outlet that Middleton has always been “like the daughter he never had.” “He shares with William an impulse to protect her,” she added. Furthermore, the king has often displayed his affection for the future queen. In October 2023, he referred to Prince William’s wife as “my beloved daughter-in-law” during his speech at a Kenya banquet.

    Earlier, a report suggested that the two even teamed up to plan a reunion between William and Prince Harry. A source claimed that the 43-year-old princess joined hands with the king to end the two brothers’ ongoing feud at a royal wedding. However, things did not seem to have gone according to plan.

    Originally reported by Suushmmita Sen on Reality Tea.

    The post Photo: Kate Middleton & King Charles’ Sweet Bond Was on Display at Royal Funeral appeared first on Mandatory.

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