Mirroring the general population, the number of medical students, doctors and, indeed, psychiatrists disclosing being neurodivergent is rising. These individuals commonly have a variety of strengths that can enhance their work, but these strengths may go unrecognised. All too often such individuals have been labelled ‘doctors in difficulty’. We begin this article with a review of contemporary thinking regarding neurodiversity, before considering specific issues facing neurodivergent doctors, specifically psychiatrists. We explore neurodivergent strengths and the evidence regarding career outcomes and mental health. We discuss the stigma that many neurodivergent psychiatrists face in the medical sphere and how difficulties may be reframed as unmet needs. We highlight initiatives that aim to change workplace culture, before discussing the concept of reasonable adjustments, alongside a wide range of practical suggestions of adjustments to consider, using the Autistic SPACE framework and the Royal College of Psychiatrists’ reasonable adjustments guidance. Finally, we consider how those in senior leadership roles can contribute to this field and provide role modelling and signposting to further information and support for neurodivergent doctors and their supervisors and line managers.

The historiography of bankruptcy and insolvency in the early modern era focusses on merchants and banks. The position of landowning noble elites in insolvency procedures has less often been explored. The Lower Austrian Lamberg seigneurial archive contains rich documentation on the insolvency procedures against the counts of Lamberg-Sprinzenstein – one of the largest landowning families in Lower Austria – between 1735 and 1768. Based on this source material, this article presents a case study treating the question of how political and judicial authorities in the Habsburg Empire dealt with insolvent aristocrats. The analysis is contextualized by a detailed reconstruction of the debt and asset structure of the Lamberg-Sprinzenstein estate. The most important policy enacted to regulate the debt crisis of the noble landowners was ‘judicial administrations’ during which a judicial official took over the administration of the landed patrimony and other assets. Compared to official norms regarding insolvency procedures, creditors had little say in how the debtors’ property was managed, and measures were taken to partially preserve the debtors’ wealth and social status. The majority of creditors were nobles. Non-noble creditors also acquired bonds on less favourable legal terms and ended up as losers in the debt crisis.

The glacial history of northeast Siberia is poorly understood compared with other high-latitude regions. Using 10Be and 26Al exposure dating together with remote sensing, we have investigated the glacial history of a remote, formerly glaciated valley in the Tas-Kystabyt Range of the Chersky Mountains in central northeast Siberia. Based on measurements from moraine boulders and bedrock samples, we find evidence for deglaciation of the valley 45.6 ± 3.4 ka ago, that is during the peak of Marine Isotope Stage 3. Satellite imagery of the range reveals at least two generations of moraines in other nearby valleys, indicating that multiple stages of glaciation took place across the Tas-Kystabyt Range. Based on calculated equilibrium-line altitudes, we speculate that the outer set of moraines is linked to the 45.6 ± 3.4 ka deglaciation event identified by our dating, while the inner generation of moraines is associated with a younger glaciation event, possibly the last glacial maximum (LGM). Thus, our results reaffirm current impressions that the maximum ice extent during the last glacial cycle was reached before the global LGM in northeast Siberia.

A wrist-hand exoskeleton designed to assist individuals with wrist and hand limitations is presented in this paper. The novel design is developed based on specific selection criteria, addressing all the Degrees of Freedom (DOF). In the conceptual design phase, design concepts are created and assessed before being screened and scored to determine which concept is the most promising. Performance and possible restrictions are assessed using kinematic and dynamic analysis. Using polylactic acid material, the exoskeleton is prototyped to ensure structural integrity and fit. Manual control, master-slave control, and electroencephalography (EEG) dataset-based control are among the control strategies that have been investigated. Direct manipulation is possible with manual control, nevertheless, master-slave control uses sensors to map user motions. Brain signals for hand opening and closing are interpreted by EEG dataset-based control, which manages the hand open-close of the exoskeleton. This study introduces a novel wrist-hand exoskeleton that improves usefulness, modularity, and mobility. While the numerous control techniques give versatility based on user requirements, the 3D printing process assures personalization and flexibility in design.

Postprandial hypotension (PPH) is defined as a postprandial decline in systolic blood pressure (SBP) of 20 mm of Hg. Some have recommended the use of acarbose (an alpha-glucosidase inhibitor) as a potential therapy for PPH based exclusively on studies of older adults with diabetes. Using a randomized placebo-controlled design, 43 older adults (23 women, 20 men, mean age 77.1 ± 0.9 years) were recruited from geriatric medicine outpatient clinics in an academic centre. Although the average decrease in SBP during the meal test was significantly attenuated in the acarbose group (standardized β = 0.724 ± 0.286, p = 0.017), the acarbose group experienced significantly more PPH events (standardized β = 0.593 ± 0.279, p = 0.040). Although acarbose attenuated the mean decrease in SBP during the meal test, it did not reduce the actual number of PPH events recorded in a general population of older adults.

ClinicalTrials.gov ID NCT01914133.

This article explores the connection between the ecclesiology and the beliefs on church-state relations of Baptists in the mid-twentieth-century United States. The author analyzes white Baptists’ reactions to the US Supreme Court rulings in Everson v. Board of Education (1947) and McCollum v. Board of Education (1948), both of which inaugurated the modern era of strict separationist Establishment Clause jurisprudence. The author also traces the development of Baptist beliefs on how the institutional church relates to individual salvation—beliefs that distinguished Baptists from both Catholics and most other Protestants—and statements from US Baptist leadership supporting church-state separation. The author demonstrates that Baptists’ beliefs on the internal, individualistic, and non-sacramental nature of salvation induced them to see any government-sponsored religious activity as likely corrupting of a person’s genuine choice of salvation. Furthermore, Baptists’ origins as a persecuted minority in Europe and the United States reinforced their idea that government-sponsored religion would lead to the suppression of true Christianity. For both reasons, then, state-sponsored religion was not God’s design. Beginning with Everson and McCollum and continuing with later cases through the 1960s, Baptist’s strict separationism became the binding interpretation of the First Amendment’s Establishment Clause through Justice Hugo Black, who authored both the Everson and McCollum majority opinions. Although no longer a Baptist when the rulings were issued, Black retained his Baptist influence on church-state issues and enshrined strict separationism into American case law for decades, leading to a Baptist triumph that many Baptists themselves would later regret and attempt to reverse.

Section 63 is one of the most widely used provisions of the Mental Health Act 1983 (MHA). Case law has evolved and established that a range of physical health treatments, ancillary to the core mental disorder, can be subsumed and authorised under s.63. This article reviews two court judgments whereby unique treatments were authorised under s.63 – the provision of clinically assisted nutrition and hydration, and renal dialysis. In doing so, it elucidates key issues around implementing s.63 and assessing potential ancillary treatments for clinical practice.

Trichinellosis is a global foodborne zoonotic disease. Numerous drugs used in its treatment exhibit inadequate absorption and diminished efficacy against encysted larvae in muscle tissue. Therefore, there is a need for innovative therapeutic agents to treat trichinellosis. Allium sativum (A. sativum), commonly known as garlic, is a bulbous plant that has been historically utilized in the treatment of various ailments. Currently, there is a paucity of data regarding the in vivo efficacy of A. sativum against trichinellosis. This study assessed the antiparasitic, anti-inflammatory, and antiapoptotic effects of A. sativum in murine models, independently or in conjunction with albendazole (ABZ), against the intestinal and muscular stages of trichinellosis. Fifty mice were equally categorized into five groups: negative control, positive control, ABZ, A. sativum, and a combination of ABZ and A. sativum. The effectiveness of the examined drugs was assessed through parasitological, biochemical, histological, and immunohistochemical methodologies. A. sativum resulted in a significant reduction of adult counts by 39.7% and larval counts by 54.4%. The inflammatory cellular infiltrate in the intestine and muscle was significantly reduced. In mice treated with A. sativum, serum levels of IFN-γ exhibited a significant increase, accompanied by a rise in Bcl-2 expression and a notable decrease in COX-2 expression. In conclusion, A. sativum demonstrates potential as a therapeutic agent for treating experimental trichinellosis, particularly during the muscle phase of the disease. It may serve as a safe promising therapy for trichinellosis.

We consider three American policy controversies that have entailed memorable drives to repeal congressional measures. Those drives have targeted the Eighteenth Amendment (Prohibition), Section 14b of the Taft–Hartley Act, and the Affordable Care Act. We do not consider the actual conduct of these repeal drives. We consider the overall policy controversies in which the drives have figured. Components of this focus include factors related to political geography, Congress’s deliberative content and style, the U.S. system of vertical federalism, the U.S. system of elections, the role of crises, and the consequences of conflict. One line of takeaway is the following. In each of these three policy enterprises, we see a kind of controversy in which extreme intensity has joined with striking geographic differentiation in views. As a practical matter, the policymaking process in these cases has enrolled a multiplicity of actors, including the states as well as the public, and it has extended across time. All this activity has arguably constituted the policymaking process. In these instances, this is how the country has been making certain of its major decisions—jaggedly and extendedly. A congressional enactment can be just a first draft.

While extensive research exists on general pornography consumption, there is limited focus on the consumption of non-preferred sexual content and its potential associated discomfort. In 2019, a total of 1,133 Spanish men aged between 18 and 40 years (M = 24.78; SD = 5.91) completed a questionnaire regarding their consumption of male–female, female–female, and male–male pornography, the attentional focus, as well as the discomfort they experienced when aroused by such materials. The results were analyzed based on five groups of sexual attraction, ranging from “exclusively heterosexual” to “exclusively gay.” Regardless of sexual attraction, men reported consuming and experiencing arousal by all three types of pornography. Exclusively heterosexual men primarily consumed and were aroused by male–female and female–female pornography, while exclusively gay men preferred male–female and male–male pornography. Men with nonexclusive sexual attraction, especially bisexual men, exhibited high levels of consumption and arousal across all types of pornography evaluated. When watching male–female pornography, exclusively heterosexual men reported focusing more on women, exclusively gay men on men, and men with nonexclusive attractions on interactions among individuals. Male–male pornography material caused the most discomfort. These findings illustrate the variety of experiences of consumption and arousal by pornography, even from featuring non-preferred sexual activities. The study also highlights the associated discomfort, particularly with male–male pornography. Further exploration is needed to understand the phenomenon behind this discomfort, such as internalized desires, and to promote a more flexible understanding of sexual identities to support inclusive and healthy sexual health practices.

Tras revisar los datos arqueotanatológicos registrados desde el siglo diecinueve y realizar el análisis bioantropológico de todos los componentes esqueléticos humanos correspondientes, exponemos por primera vez un análisis integral del patrón mortuorio de Palenque-Lakamha’, cuya monumentalización data del Clásico Maya. Describimos la amplia distribución de sepulturas en los diferentes sectores del asentamiento, el elevado número de edificios dedicados a las prácticas funerarias, la preferencia por el uso de cistas, la frecuente colocación de más de un individuo en el mismo espacio sepulcral y la estandarización de la posición extendida en decúbito dorsal, con orientación al norte.

Un aspecto sobresaliente es el reingreso a los sepulcros, particularmente en entierros colectivos, depositados en contenedores de piedra, que presentan remoción, desplazamiento o ingreso de muertos y/o artefactos. Además de la identificación de esta secuencia funeraria que explica la desviación del patrón mortuorio, se propone una interpretación basada en datos etnográficos para entender la interacción entre vivos y muertos.

La distribución de los sepulcros, la prominencia de la actividad post-inhumación y los datos iconográficos y epigráficos sugieren que Palenque-Lakamha’ pudo haber sido un lugar vinculado al pasaje liminal hacia el inframundo, donde la frecuente interacción con los muertos y el importante número de mausoleos permitía entablar diálogos con el sagrado y, por ende, renovar los ciclos cósmicos.

An interesting aspect of the Nicene Creed is that it asks its adherents to not only affirm their belief in God, the Father, the Son, and the Holy Spirit but also their belief in one, holy, catholic, and apostolic Church. The call to believe in the Church raises at least two interrelated questions: (1) What does it mean for the Church to be one, holy, catholic, and apostolic? (2) What ought to be the nature of the Christian’s faith in the Church? This paper explores these two questions by drawing on Anselm of Canterbury’s ecclesiology and his well-known approach to the relationship between faith and reason, fides quaerens intellectum. While many have discussed the importance of faith seeking understanding for Anselm as it pertains to God, this paper will focus on how Anselm’s understanding of the interworking of belief and understanding can help us think about what it means to believe in the Church.

The purpose of this retrospective population-based study of adults aged ≥50 years was to examine associations between older age, multimorbidity, and self-rated perceptions of health with frequent emergency department (ED) visits. Using Canadian Community Health Survey (CCHS) 2015–16 data, a multivariate logistic regression model was generated to evaluate associations between predictor variables and frequent ED use. The study sample included data for 57,138 participants across Canada, equating to approximately 13,091,592 when sampling weights applied. Frequent ED use was associated with older age, male sex, multimorbidity, and lower household income. Lower self-rated levels of health were most strongly associated with frequent ED use. Having a primary health care provider was not a significant predictor in univariate or multivariate analyses. Older adults who are frequent ED attenders are a distinct population whose characteristics need to be understood to target strategies for those who most need them to improve quality care and outcomes.