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The use of community treatment orders (CTOs) has increased in many jurisdictions despite very limited evidence for their efficacy. In this context, it is important to investigate any differences in outcome by subgroup.
Aims
To investigate the variables associated with CTO placement and the impact of CTOs on admissions and bed-days over the following 12 months, including differences by diagnosis.
Method
Cases and controls from a complete jurisdiction, the state of Queensland, Australia, were analysed. Administrative health data were matched by age, sex and time of hospital discharge (index date) with two controls per case subject to a CTO. Multivariate analyses were used to examine factors associated with CTOs, as well as the impact on admissions and bed-days over the 12 months after CTO placement. Registration: Australian and New Zealand Clinical Trials Registry (ACTRN12624000152527).
Results
We identified 10 872 cases and 21 710 controls from January 2018 to December 2022 (total n = 32 582). CTO use was more likely in First Nations people (adjusted odds ratio = 1.14; 95% CI: 1.06–1.23), people from culturally diverse backgrounds (adjusted odds ratio = 1.45; 95% CI: 1.33–1.59) and those with a preferred language other than English (adjusted odds ratio = 1.21; 95% CI: 1.02–1.44). When all diagnostic groups were considered, there were no differences in subsequent admissions or bed-days between cases and controls. However, both re-admissions and bed-days were significantly reduced for CTO cases compared with controls in analyses restricted to non-affective psychoses (e.g. adjusted odds ratio = 0.77, 95% CI: 0.71–0.84 for re-admission).
Conclusions
Queenslanders from culturally or linguistically diverse backgrounds and First Nations peoples are more likely to be placed on CTOs. Targeting CTO use to people with non-affective psychosis would both address rising CTO rates and mean that people placed on these orders derive possible benefit. This has implications for both clinical practice and policy.
Drawing on the two-factor model of organizational justice and social exchange theory, this study investigates the mediating roles of procedural and distributive justice in the relationship between work locus of control (WLOC) and leader–member exchange (LMX). Using data collected from two cultural contexts – the United States and South Korea – this research further examines whether culture moderates the indirect relationship between WLOC and LMX through perceived justice. The findings indicate that subordinates with an internal WLOC tend to report higher-quality LMX relationships, and that both procedural and distributive justice partially mediate this relationship. Moderated mediation analyses reveal that the indirect effects of WLOC on LMX via justice perceptions are significantly stronger in the U.S. sample than in the Korean sample. These results contribute to the literature by identifying perceived justice as a key psychological mechanism linking individual traits to relational outcomes at work, and by highlighting how cultural values shape this process.
Seed dormancy is the key factor determining weed emergence patterns in the field. Alopecurus myosuroides (black grass) is a serious cereal weed in Europe that experiences two emergence peaks affecting winter and spring cereals, respectively. Seedlings that emerge in autumn encounter a period of cold winter temperatures, whereas those that emerge in spring do not. In this work, we investigated the effects of this overwintering during vegetative growth on the primary seed dormancy of the offspring. Alopecurus myosuroides plants were propagated under controlled conditions where a proportion of the population was subjected to a simulated winter period (vernalization) as seedlings. The offspring produced by vernalized plants was significantly more dormant, requiring longer after-ripening and cold stratification treatments to germinate at warm temperatures. However, there was no difference in the range of temperatures under which dormant seeds germinated. We hypothesized that this difference in dormancy was the result of an epigenetic memory of vernalization. Global changes in DNA methylation of seeds were quantified using an ELISA-based approach. Imbibition in dormant seeds produced by vernalized plants was associated with a global demethylation event that was not observed in the offspring of plants that had not been vernalized. Taken together, these results demonstrate the importance of temperature at different stages of the plant lifecycle in determining dormancy levels and consequently weed emergence patterns in the field.
The original declarative procedural reflective (DPR) model is a well-established model of therapist knowledge and skill development. To date, although it has been used to guide reflection and discussion around personal and practitioner selves, it has not emphasised the various intersecting identities of practitioners and how these interact within wider concepts such as power, society, service contexts and the patient and supervisory relationships. The learning, development and implementation of CBT skills does not occur in a vacuum or separate to the practitioner identities however relatively little has been written on this. This paper aims to expand the original DPR model to illustrate potential ways that social context, identity and power could be considered within CBT training, delivery and supervision. It delineates and explores the additional components of the model (i.e. practitioner identity(s), context/society and power) and then provides examples of how this framework could inform key CBT activities (including low-intensity CBT).
Key learning aims
(1) We aim to (re-) familiarise the reader with the original DPR model of practitioner development and how this applies to CBT practitioners explicitly including low-intensity CBT practitioners (from novice learners through to expert).
(2) We aim to help the reader understand how the key elements of the original DPR model (declarative knowledge, procedural skills, reflective system and therapist stance) can be applied to specific content areas when working with individuals with minoritised identities.
(3) The reader will be introduced to an adapted DPR model which provides a framework for CBT practitioners to reflect on, and be able to conceptualise the influence of their own social identities, social context, power and how this may impact on their development and implementation of declarative knowledge, procedural skills and reflective skills.
(4) We aim to help the reader understand how an adapted DPR model can provide a helpful framework to guide skill development in working with difference and ensuring practitioners have the knowledge and skills required to provide sensitive and effective therapy, supervision and training to individuals with identities that may be different from the practitioner.
We study experimentally the starting vortices shed by airfoils accelerating uniformly from rest in superfluid helium-4 (He II). The vortices behave apparently as if they were moving in a classical Newtonian fluid, such as air or water. Specifically, the starting vortex positions obtained from the experimental data are found to be very close to those computed numerically in a Newtonian fluid, at sufficiently small times, when self-similar behaviour is expected to occur, and for Reynolds numbers ranging between approximately $5 \times 10^2$ and $5 \times 10^5$. The result indicates neatly that turbulent flows of He II can be very similar to classical flows of Newtonian fluids, when thermal effects can be neglected and at sufficiently large flow scales, i.e. the study demonstrates that He II could also be employed to study classical Newtonian flows.
This study examines how racial identity affects legislative responsiveness in Mexico using an email-based audit experiment. Emails from simulated Indigenous, Mestiza, and European-White constituents were sent to all 626 federal legislators to test whether perceived identity shapes replies and their quality. Contrary to expectations, Indigenous-named constituents received significantly higher response rates that were more personalized and helpful than their European-White counterparts, while Mestiza-named constituents showed no significant differences in response rates. We found no coalition-based differences, though power was limited, and responsiveness declined in districts with larger Indigenous populations, revealing how national inclusion norms may be moderated by local demographic and political dynamics.
Mountainous regions host globally unique biodiversity, but face growing threats from climate and land-use change. The Alps stand out as a key mountain range in Europe, where the ski industry is extensive and impacts ecosystems and their associated biodiversity. However, climate change is projected to reduce natural snow precipitation, thus understanding snow dynamics and the ski industry’s role is crucial for developing effective conservation strategies. Ski-piste creation generally has detrimental consequences for mountain biodiversity, yet pistes often retain substantial snow throughout spring that, when melting, may create favourable foraging conditions for mountain birds. This study investigates whether ski-pistes provide suitable foraging habitat and explores their broader importance for mountain avifauna. Field surveys in spring 2023 in the western Italian Alps recorded 17 bird species using the melting snow on ski-pistes as a foraging habitat. Snow presence was a significant factor influencing bird presence. Birds systematically selected areas with intermediate snow cover interspersed with muddy patches, a microhabitat that likely has a high availability of invertebrate prey emerging from the soil. Given that snow is retained on ski-pistes for longer than on the surrounding habitat, the pistes may represent a useful source of food for mountain birds in spring. However, this needs to be considered in relation to the negative impacts of skiing on alpine biodiversity, which may include a likely increased reliance on artificial snow in response to the projected decline in natural snow precipitation under climate change. Understanding these effects is essential to ensure that future conservation strategies support mountain bird communities without exacerbating the environmental costs associated with artificial snow production.
This article1sets out to reassess the idea, repeated by many scholars, that there was a bishop from the Central Asian city of Qumul (or Hami) who was present in Baghdad around the time when one patriarch of the Church of the East – Makkika II – was buried and another – Denḥa I – was consecrated. After an initial consideration of what we know about the city of Qumul/Hami, we examine the various authors who have held to this idea and the sources, both primary and secondary, which they invoke as proof that the idea is correct. Gradually moving back to the earliest witnesses, we eventually arrive at the Maronite scholar Joseph Assemani’s Bibliotheca Orientalis Clementino-Vaticana and the fourteenth-century primary source, Ṣalībā ibn Yūḥannā. A suggestion is made for how the idea originated and developed, thanks in part to the account of Marco Polo, but more definitively to Michel Le Quien’s Oriens Christianus.
Lexical borrowing may provide valuable clues about the sociohistorical context of language contact. Here we explore patterns of vocabulary transfer between languages from three families (Kx’a, Tuu, Khoe-Kwadi) comprising the linguistic unit commonly referred to as Southern African Khoisan. In our data set, 20% of 1,706 roots are shared between at least two families. By applying a carefully chosen set of linguistic and extralinguistic criteria, we were able to trace the origin of 71% of shared roots, with the remaining 29% constituting good candidates for ancient contact or shared common ancestry of the forager families Kx’a and Tuu. More than half of the shared roots for which an origin could be determined trace back to Khoe-Kwadi and were borrowed into languages of other families within two major confluence zones with different sociohistorical profiles: (i) the Central Kalahari characterized by egalitarian interaction between languages of all three families and (ii) the southern and south-western Kalahari Basin fringes showing unilateral transfer from Khoe-Kwadi-speaking herders into resident forager groups. The findings of this study complement genetic and archaeological research on southern Africa and testify to the value of linguistics in the multidisciplinary inference of contact and migration scenarios.
This collection gathers thirteen contributions by a number of historians, friends, colleagues and/or students of Jinty’s, who were asked to pick their favourite article by her and say a few words about it for an event held in her memory on 15 January 2025 at King’s College London. We offer this collection in print now for a wider audience not so much because it has any claim to be exhaustive or authoritative, but because taken all together these pieces seemed to add up to a useful retrospective on Jinty’s work, its wider context, and its impact on the field over the decades. We hope that, for those who know her work well already, this may be an opportunity to remember some of her classic (and a few less classic) articles, while at the same time serving as an accessible introduction to her research for anyone who knew her without necessarily knowing about her field, as well as for a new and younger generation of readers.
While apophatic theology has been quickly dismissed by the vast majority of analytic philosophers, Samuel Lebens is among the few who has tried to show that such a theological position is tenable by appealing to two main philosophical moves. The first move is that many of our claims about God are false (or nonsensical). The second move is that such false (or nonsensical) claims about God are illuminating and/or therapeutic. This article presents Lebens’s account of apophatic theology, and defends it from the main criticisms. However, it also shows that, contrary to what has been suggested by Lebens himself, the disjunction which appears in the first move has to be understood as exclusive, that is, either many of our claims about God are false or many of our claims about God are nonsense. Tertium non datur. Moreover, this article argues that, in both cases, Lebens’s account of apophatic theology stumbles upon some important issues. For, if many of our claims about God are taken to be false or nonsensical, Lebens fails to explain how such claims can be illuminating and/or therapeutic.
Motivational interviewing is a patient-centred communication approach designed to facilitate behavioural change by enhancing intrinsic motivation. Despite its widespread global utility, research on the training and applications of motivational interviewing among resident physicians in Oman remains untapped.
Aims
To examine the awareness, training experiences and clinical implementation of motivational interviewing among psychiatry and family medicine residents enrolled with the Oman Medical Specialty Board (OMSB).
Method
A qualitative study was conducted using semi-structured interviews and focus group discussions with 22 resident physicians from psychiatry and family medicine programmes. Data were analysed using thematic analysis to identify key themes regarding motivational interviewing training and its application in clinical settings.
Results
Three primary themes emerged: (a) residents’ understanding and application of motivational interviewing principles, (b) barriers to the integration of motivational interviewing into clinical practice, such as time constraints and insufficient training, and (c) the need for culturally adapted approaches to motivational interviewing tailored to Omani patients. Although participants appreciated the utility of motivational interviewing to improve patient engagement, they reported inconsistent training and limited opportunities to practise the technique in clinical settings.
Conclusions
The study highlights significant gaps in motivational interviewing training and practice within Oman’s residency programmes. It underscores the necessity for comprehensive, structured motivational interviewing curricula that are sensitive to the local context. Enhancing practical training opportunities may improve the integration of motivational interviewing into patient care, particularly in managing chronic diseases and addiction.
We investigate the consequences of periodic, on–off glucose infusion on the glucose–insulin regulatory system based on a system-level mathematical model with two explicit time delays. Studying the effects of such infusion protocols is mathematically challenging yet a promising direction for probing the system response to infusion. We pay special attention to the interplay of periodic infusion with intermediate-time-scale, ultradian oscillations that arise as a result of the physiological response of glucose uptake and back-release into the bloodstream. By using numerical solvers and numerical continuation software, we investigate the response of the model to different infusion patterns, explore how these patterns affect the overall levels of glucose and insulin, and how this can lead to entrainment. By doing so, we provide a road-map of system responses that can potentially help identify new, less-invasive, test strategies for detecting abnormal responses to glucose uptake without falling into lockstep with the infusion pattern.
In the early months of 2020, governments faced the rapid spread of COVID-19. To navigate the storm of conflicting information about the danger posed by this new disease, countries sought guidance about when and how to respond to it. We argue that the World Health Organization (WHO) played a central role in the diffusion of policies against COVID-19 by exercising leadership. We develop the concept of leadership as a diffusion mechanism to explain how the WHO influenced governments to close schools and workplaces and cancel public events within weeks, despite its lack of strong enforcement mechanisms. Results from five event-history models show the significance of the WHO’s pandemic declaration on March 11, 2020 that mobilized countries to adopt the measures recommended by the organization. However, that declaration did not affect the diffusion of policies that the WHO advised against adopting.
Comprehensive cognitive remediation improves cognitive and functional outcomes in people with serious mental illness, but the specific components required for effective programs are uncertain. The most common methods to improve cognition are facilitated computerized cognitive training with coaching and teaching cognitive self-management strategies. We compared these methods by dismantling the Thinking Skills for Work program, a comprehensive, validated cognitive remediation program that incorporates both strategies.
Methods
In a randomized controlled trial we assigned 203 unemployed people with serious mental illness in supported employment programs at two mental health agencies to receive either the full Thinking Skills for Work (TSW) program, which included computerized cognitive training (based on Cogpack software), or the program with cognitive self-management (CSM) but no computer training. Outcomes included employment, cognition, and mental health over 2 years. To benchmark outcomes, we also examined competitive work outcomes in a similar prior trial comparing the TSW program with supported employment only.
Results
The TSW and CSM groups improved significantly on all outcomes, but there were no differences between the groups. Competitive work outcomes for both groups resembled those of the TSW program in a prior trial and were better than the supported employment-only group in that study, suggesting that participants in both groups benefited from cognitive remediation.
Conclusions
Providing facilitated computerized cognitive training improved neither employment nor cognitive outcomes beyond teaching cognitive self-management strategies in people receiving supported employment. Computerized cognitive training may not be necessary for cognitive remediation programs to improve cognitive and functional outcomes.
Complex, knowledge-intensive projects present challenges in terms of defining the work and determining roles. Time pressure makes these challenges more acute. External leadership can provide necessary direction and shape, giving the work a clear focus guiding the team’s efforts. With hackathons and rapid product prototyping more feasible than they ever have been, collaborations that fast-track innovation by drawing together teams of unfamiliar experts are more common than ever.
Method
Drawing on the process perspective on creative action, we seek to understand the generation of new ideas and solutions when teams are working within an extremely brief time frame of one week. The influence of mentors on these interactions has received limited attention. We fill this gap through a study of fifteen case teams who participated in a week-long boot camp where they generated proposals for public health studies, guided by mentors who were experts in the field. The teams’ proposals were evaluated by independent panels, and the evaluations provided metrics for team success.
Results
Our results suggest that even in short-term teams, the timing of mentor interventions is critical to team success.
In mammals, pregnancy and lactation are marked by maternal calcium stress and bone resorption, leading to reduced bone mineral density. In humans, these periods may partly explain the higher prevalence of osteoporosis in older women compared with men, but lactation patterns in modern humans may reflect cultural influences rather than natural conditions. The extent to which these findings apply to wild-living mammals remains unknown. We measured urinary C-terminal crosslinking telopeptide of Type I collagen (CTX-I) levels, a bone resorption marker, during pregnancy in wild and zoo-housed bonobos (Pan paniscus) and during lactation in wild bonobos. Studying wild-living primates such as bonobos can provide insights into ancestral reproductive adaptations. We found an increase in CTX-I levels towards the end of pregnancy in zoo-housed and primiparous wild females. Contrary to expectations, CTX-I levels during early lactation are lower than in other reproductive phases. This pattern diverges from the assumption that lactation increases bone resorption. Our findings suggest that wild bonobos may rely on a combination of physiological and behavioral strategies to modulate bone metabolism during lactation. Bone resorption may serve as a physiological back-up when behavioral or dietary strategies cannot fully meet calcium demands. These flexible responses, shaped by fluctuating environmental conditions and prolonged maternal investment, provide insight into evolutionary pressures on skeletal health and may inform strategies to mitigate bone loss in humans.
In this article, we focus on the systemic expected shortfall and marginal expected shortfall in a multivariate continuous-time risk model with a general càdlàg process. Additionally, we conduct our study under a mild moment condition that is easily satisfied when the general càdlàg process is determined by some important investment return processes. In the presence of heavy tails, we derive asymptotic formulas for the systemic expected shortfall and marginal expected shortfall under the framework that includes wide dependence structures among losses, covering pairwise strong quasi-asymptotic independence and multivariate regular variation. Our results quantify how the general càdlàg process, heavy-tailed property of losses, and dependence structures influence the systemic expected shortfall and marginal expected shortfall. To discuss the interplay of dependence structures and heavy-tailedness, we apply an explicit order 3.0 weak scheme to estimate the expectations related to the general càdlàg process. This enables us to validate the moment condition from a numerical perspective and perform numerical studies. Our numerical studies reveal that the asymptotic dependence structure has a significant impact on the systemic expected shortfall and marginal expected shortfall, but heavy-tailedness has a more pronounced effect than the asymptotic dependence structure.
The “EU Vaccines Strategy” launched by the European Commission in June 2020 aimed to ensure vaccine safety, equitable access, affordability, swift distribution, and global solidarity for COVID-19 vaccines. This study critiques the Commission’s centralized procurement approach, focusing on Advance Purchase Agreements (APAs) through a literature review, policy analysis, and a case study of the EU-AstraZeneca’s APA. It identifies critical challenges, including transparency deficits, accountability gaps, and anticompetitive practices by vaccine producers that undermine equitable access. Drawing on these insights, the study proposes the FACER Framework — Fairness, Accountability, Competition Law, Ethics of Innovation, and Resilience — a novel model integrating the Treaty on the European Union (TEU) and the Treaty on the Functioning of the European Union (TFEU) oversight with ethical principles. By embedding legal and moral accountability, FACER offers EU policymakers a robust tool to enhance vaccine strategy and equity in future health crises.