The ability to substitute some resource or tool for another is a common and important human ability. For example, in cooking, we often lack an ingredient for a recipe and we solve this problem by finding a substitute ingredient. There are various ways that we may reason about this. Often we need to draw on commonsense reasoning to find a substitute. For instance, we can think of the properties of the missing item, and try to find similar items with similar properties. Despite the importance of substitution in human intelligence, there is a lack of a theoretical understanding of the faculty. To address this shortcoming, we propose a commonsense reasoning framework for conceptualizing and harnessing substitution. In order to ground our proposal, we focus on cooking. Though we believe the proposal can be straightforwardly adapted to other applications that require formalization of substitution. Our approach is to produce a general framework based on distance measures for determining similarity (e.g. between ingredients, or between processing steps), and on identifying inconsistencies between the logical representation of recipes and integrity constraints that we use to flag the need for mitigation (e.g. after substituting one kind of pasta for another in a recipe, we may identify an inconsistency in the cooking time, and this is resolved by updating the cooking time).

Intolerance of uncertainty (IU) is a development and maintenance factor for depression and anxiety. Previous reviews found that it associated with anxiety in children and adolescents. However, there was insufficient evidence at the time to review its association with depression in this population. 20 studies investigating the relationship between IU and depression in children and adolescents were identified. Random effects meta-analysis was used to aggregate cross-sectional associations, with age, gender, and measure as moderators. A narrative review of longitudinal findings from relevant studies (K=6) was also conducted. Meta-analysis of cross-sectional associations found an overall effect size of r=0.47. There was limited evidence that age or gender moderated the effect, however there was a significant moderating effect of measure. Namely, when including studies using 'child-friendly' measures (i.e., developed and normed with children as opposed to adults), the effect size was r=0.37. Another analysis revealed that the inhibitory IU subscale was more strongly associated with depression than prospective IU. Longitudinal findings suggested that the association between IU and depression persists over time. Studies were limited to those published in English and including general population samples (e.g., typically developing, without significant medical needs). There is a medium-strong association between IU and depression symptoms in children and adolescents. However, it may be overestimated by the use of IU measures that are not child-friendly. Future research can further extend the evidence-base through careful measure selection, as well as longitudinal and experimental designs.

Rising living costs and changes to alcohol taxation influence drinking behaviours. This study aimed to examine associations between financial hardship and alcohol reduction attempts in the context of a cost-of-living crisis and alcohol tax reforms in Great Britain. We analysed data from 6063 adults (≥18 years) drinking at risky levels (AUDIT-C ≥5) participating in a nationally representative survey during January-March 2023, 2024, and 2025. Data were analysed cross-sectionally and pooled across years for the primary analysis. Participants were asked whether they had attempted to reduce their alcohol consumption in the past year and, if so, whether the most recent attempt was motivated by cost. They also reported their level of alcohol consumption, perceived financial situation, housing tenure, past-year rent/mortgage arrears, and past-month psychological distress. Overall, 38.3% [36.9-39.7%] reported attempting to reduce their alcohol consumption, and 7.3% [6.5-8.1%] reported cost as a motive for these attempts. Cost-motivated attempts were strongly patterned by socioeconomic circumstances, being most common among those experiencing financial hardship, younger adults, women, those drinking more heavily, and individuals with elevated psychological distress. Odds of cost-motivated reduction attempts increased progressively with greater financial hardship (e.g., adjusted OR up to 5.42 [95%CI 3.13-9.40] among those finding their financial situation very difficult vs. those living comfortably). By contrast, there was no clear association between hardship and alcohol reduction attempts in general. Associations between hardship and cost-motivated reduction attempts were consistent across levels of alcohol consumption, psychological distress, and survey year. Amid the cost-of-living crisis and recent alcohol duty reforms, cost has emerged as a key motive for alcohol reduction attempts among adults drinking at risky levels, particularly those facing financial and psychological vulnerability. Support for these groups is critical to ensure cost-driven attempts translate into meaningful reductions in alcohol-related harm.

Avoidant/restrictive food intake disorder (ARFID) involves restrictive eating driven by sensory sensitivity, low interest in food, or fear of negative consequences of eating. ARFID affects males and females equally and presents across the weight spectrum. Leptin, an anorexigenic hormone linked to adiposity, may contribute to low hunger and early satiety in ARFID. Prior findings indicate low leptin levels in low-weight females with ARFID; however, the role of leptin in ARFID across weight status and sex remains unknown. We hypothesized that youth with full/subthreshold ARFID, including a subgroup of low-weight males, would exhibit lower fasting leptin levels than healthy controls (HCs). We explored cross-sectional and longitudinal associations between leptin and clinical characteristics. Participants were youth aged 10-23 years (BMI percentile M [SD] = 41.4 (33.6)) with full/subthreshold ARFID (n = 95; 49.5% female) and HCs (n = 28; 50.0% female). At baseline, participants completed questionnaires, a fasted blood draw, and a diagnostic interview for ARFID, readministered at 1- and 2year follow-ups. Leptin levels did not differ between ARFID and HC groups. Low-weight ARFID males had significantly lower leptin than HC males (η 2 = 0.258); however, this difference was nonsignificant after adjusting for BMI percentile. Leptin showed medium-to-large positive associations with age, BMI, and anxiety but not appetite or ARFID severity. Baseline leptin did not predict symptom or weight changes longitudinally. Hypoleptinemia was only evident in low-weight ARIFD and strongly correlated with BMI percentile. However, relationships with anxiety may suggest additional roles of leptin in underlying ARFID psychopathology. Findings should be replicated in larger, more representative samples.

The 4th UN General Assembly declaration on non-communicable diseases (NCDs) and mental health, adopted on Dec 15, 2025, was notable for its explicit inclusion of dementia, bringing dementia prevention into focus as an international public policy priority.1 A central question therefore becomes how dementia prevention will be prioritised, resourced, and implemented and how it will be integrated into existing NCD policies and health-system strategies (appendix).

Objective.Ultrasound (US) is commonly used to guide minimally invasive procedures; however, its effectiveness is often limited by poor needle-tip visibility. This work presents a 3D US imaging and needle-tip tracking system based on US multilateration, toward real-time, safe and efficient guidance.Approach.The proposed system integrates a fiber-optic hydrophone within a medical needle to receive US transmissions from a sparse 2D matrix array probe used for 3D imaging. Chirp excitation was employed to improve the signal-to-noise ratio and enable robust time-of-arrival estimation. A multilateration algorithm was employed for needle-tip localization relative to the US probe, requiring fewer US elements and achieving substantially faster performance than existing methods.Main results.The system achieved spatial tracking accuracy of1.27±0.65 mm using only 13 active elements, representing an order-of-magnitude increase in tracking speed from 3.77 to 45.45 Hz compared to a conventional delay-and-sum-based tracking algorithm with 256 elements. The translational potential of the system was further demonstrated withex vivochicken tissue, and a clinically realistic femoral nerve block phantom.Significance.These results demonstrate the feasibility of a multilateration-based system that combines 3D anatomical visualization with needle tracking. With further improvements towards real-time operation and validation under clinically relevant conditions, this approach could improve the precision and safety of US-guided interventions.

Patient-reported pain during intravitreal injection (IVI) may vary by injection quadrant and influence adherence to repeated treatments. Hence, this study aimed to quantify whether patient-reported pain differs by IVI quadrant and identify the least-painful approach. We searched 13 literature databases on 15 October 2025 for clinical studies reporting patient-reported IVI pain stratified by injection quadrant (superotemporal [ST], superonasal [SN], inferotemporal [IT], inferonasal [IN]). Random-effects meta-analyses synthesized mean differences (MD) in 0-10 visual analogue scale (VAS) pain across all six pairwise quadrant contrasts. All eligible studies were included for a qualitative review and a meta-analysis. The review was prospectively registered (PROSPERO CRD420251164189). Seven studies comprising 2048 IVI were included (ST 611, SN 469, IT 556, IN 412). Most injections involved anti-VEGF agents. All injections were performed under topical anesthesia (100%; drops or gel), with no subconjunctival anesthesia reported (0%), and pain was recorded immediately post-procedure using VAS-derived scales. Across all six pairwise contrasts, pooled mean differences between quadrants were small (typically < 1 VAS unit on a 0-10 scale), and all 95% confidence intervals crossed zero. Across quadrant comparisons, pooled pain differences were small and inconsistent; none of the pairwise pooled estimates demonstrated a statistically consistent difference, and between-study heterogeneity was substantial to considerable (I2 generally > 80%). Current evidence does not demonstrate a clearly less painful quadrant for intravitreal injections. Estimates varied across studies and heterogeneity was substantial, limiting confidence in any single average quadrant effect. Efforts to minimize IVI-related pain should prioritize optimized anesthesia protocols, communication, and injection technique, while future studies should standardize pain measurement and quadrant allocation to clarify whether subtle quadrant effects exist. PROSPERO registration:CRD420251164189.

Indocyanine green fluorescence angiography is being increasingly used in colorectal surgery to reduce anastomotic leak risk, but few studies have analyzed its cost efficacy. In this study, cost modeling was used to compare costs in the United States using versus not using indocyanine green fluorescence angiography. Exhaustive searches of PubMed/MEDLINE, EMBASE, and Scopus were used to identify all meta-analyses and randomized controlled trials assessing the effectiveness of indocyanine green fluorescence angiography in reducing anastomotic leaks. Additionally, we conducted our own meta-analysis restricted to randomized controlled trials with ≥100 patients in both indocyanine green fluorescence angiography and control groups. Three years (2021-2023) of Medicare Provider Analysis and Review billing data were then employed to identify direct health care costs. Minimum, intermediate, and maximum cost analysis models were created using indocyanine green fluorescence angiography-associated anastomotic leak reduction rates identified by synthesizing the results of meta-analyses and randomized controlled trials, procedural and complication-related costs identified via Medicare Provider Analysis and Review, and $225 as the per-unit cost of indocyanine green administration. Synthesis of the results of our own and 19 published meta-analyses revealed a 51.9% reduction in anastomotic leak rate with indocyanine green fluorescence angiography, whereas 5 meta-analyses restricted to randomized controlled trials, including our own, revealed level 1 evidence of at least a 36.5% reduction. Minimum and maximum cost analysis models were generated using conservative anastomotic leak reduction rates of 35% and 50%, from which mean per-patient cost reductions ranged from $962 to $1,138, and overall health care system savings ranged from $71 million to $84 million. For anastomotic assessments in colorectal surgery, indocyanine green fluorescence angiography reduces direct per-patient health care costs in the United States by $962 to $1,138. Additional savings may be derived from reduced rehospitalization and reoperation rates.

To provide recommendations for the most appropriate endovascular intervention of femoropopliteal (FP) arterial disease based on plaque characterization. A panel of 22 physicians from multiple disciplines participated in a modified Delphi consensus, leveraging the RAND/UCLA Appropriateness Method. Panelists engaged in 2 rounds of voting, following a literature review, with an in-person discussion prior to the second round of voting. A rigorous statistical approach was used to analyze the points of agreement and disagreement. Consensus-based recommendations on the most appropriate endovascular approaches for treating patients with FP lesions, stratified by lesion morphology, were generated. Overall, 490 individual items were included in the voting, 458 (93%) of which achieved consensus and 32 (7%) were nonconsensus items, based on a priori criteria under the following categories: (a) recommendations on method for determining plaque morphology, (b) preferred endovascular devices for vessel preparation and definitive treatment stratified by (i) plaque morphology and (ii) Tosaka classification of in-stent restenosis, and (c) vessel preparation device safety-related considerations. This international, multidisciplinary consensus provides evidence- and expert-informed recommendations for vessel preparation and definitive treatment of FP arterial disease, tailored to plaque morphology. These consensus recommendations aim to support clinical decision making and promote best interventional practices by serving as an expert opinion supplement to existing guideline-based care pathways.