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Parental psychopathology is a known risk factor for child autistic-like traits. However, symptom-level associations and underlying mechanisms are poorly understood.
Methods
We utilized network analyses and cross-lagged panel models to investigate the specific parental psychopathology related to child autistic-like traits among 8,571 adolescents (mean age, 9.5 years at baseline), using baseline and 2-year follow-up data from the Adolescent Brain Cognitive Development study. Parental psychopathology was measured by the Adult Self Report, and child autistic-like traits were measured by three methods: the Kiddie Schedule for Affective Disorders and Schizophrenia for DSM-5 autism spectrum disorder (ASD) subscale, the Child Behavior Checklist ASD subscale, and the Social Responsiveness Scale. We also examined the mediating roles of family conflict and children’s functional brain connectivity at baseline.
Results
Parental attention-deficit/hyperactivity problems were central symptoms and had a direct and the strongest link with child autistic-like traits in network models using baseline data. In longitudinal analyses, parental attention-deficit/hyperactivity problems at baseline were the only significant symptoms associated with child autistic-like traits at 2-year follow-up (β = 0.014, 95% confidence interval [0.010, 0.018], FDR q = 0.005), even accounting for children’s comorbid behavioral problems. The observed association was significantly mediated by family conflict (proportion mediated = 11.5%, p for indirect effect <0.001) and functional connectivity between the default mode and dorsal attention networks (proportion mediated = 0.7%, p for indirect effect = 0.047).
Conclusions
Parental attention-deficit/hyperactivity problems were associated with elevated autistic-like traits in offspring during adolescence.
There is a need for better collaborative care between services to improve healthcare provision for people with intellectual disabilities. In the UK, the learning disability psychiatry multidisciplinary team (MDT) is a specialist team responsible for providing and coordinating care for people with intellectual disabilities.
Aims
To document learning disability MDT perspectives on factors influencing healthcare quality for people with intellectual disabilities.
Method
Healthcare professionals who were members of a learning disability MDT within a National Health Service Trust in the West Midlands were purposively sampled for interview (n = 11). Participants included psychiatrists, nurses, occupational therapists and speech and language therapists. Data were analysed thematically using Braun and Clarke’s six-stage approach.
Results
Factors influencing the quality of healthcare provision included: the learning disability MDT working to overcome systemic barriers; the consequences of specific failures within mainstream healthcare services, such as diagnostic overshadowing; inadequate use of information collated in health passports; and inadequate capacity assessments of people with intellectual disabilities. Improvements in healthcare provision for people with intellectual disabilities require better accessibility to healthcare and better training for healthcare professionals so they can understand the health needs of people with intellectual disabilities.
Conclusions
A rapid review of practices around health passports for people with intellectual disabilities should be conducted. Healthcare professionals working in mainstream healthcare services need an increased awareness of the harms of diagnostic overshadowing and inadequate capacity assessments. Conclusions are based on findings from MDTs within one health board; future work may focus on understanding perspectives from different teams.
Plant-soil microbial interactions play a central role in maintaining biodiversity and coexistence in terrestrial ecosystems. However, to what extent plant-soil feedbacks (PSFs) operate in tropical Afromontane forests remains unclear. In this study, we conducted a PSF shade house experiment using six tree species exhibiting diverse life-history strategies and abundances in a sub-tropical montane forest in Nigeria. Seedlings were grown under controlled conditions in sterilised soil with or without soil inoculum collected under mature trees of each of the six species. We assessed whether conspecific tree seedlings’ performance was altered in comparison to heterospecific seedlings when grown in the soil of their adult trees. Seedling growth did not significantly differ between inocula from conspecific and heterospecific adults in five of the six species tested, indicating no evidence of PSFs. In Garcinia smeathmannii, we found a significant increase in seedling growth when grown in conspecific soil inocula. Given that no PSFs were observed in five out of six species, our study suggests that PSFs may play a limited role in the performance of some species in this Afromontane ecosystem. Nonetheless, the facilitative interaction noted in Garcinia smeathmannii indicates a nuanced ecological dynamic worth further exploration.
The RDA for dietary protein is likely insufficient for individuals with cystic fibrosis (CF). This study sought to characterise protein intake and diet quality in adults with cystic fibrosis (awCF), before and after elexacaftor/tezacaftor/ivacaftor (ETI) therapy, compared with healthy controls. Dietary intake was assessed by diet diary in awCF at baseline (BL, n 40) and at follow-up > 3 months post ETI therapy (follow-up (FUP), n 40) and in age-matched healthy controls (CON, n 80) free from known disease at a single time point. Protein intake dose and daily distribution, protein quality, protein source and overall diet quality were calculated for each participant. Both CON (1·39 (sd 0·47) g·kg–1·day–1) and CF (BL: 1·44 (sd 0·52) g·kg–1·day–1, FUP: 1·12 (sd 0·32) g·kg–1·day–1) had a higher mean daily protein intake than the protein RDA of 0·75g·kg–1·day–1. There was a significant reduction in daily protein intake in the CF group at FUP (P = 0·0003, d = 0·73), with levels below the alternative suggested dietary intake of ≥ 1·2 g·kg–1·day–1. There were no sex differences or noticeable effects on protein quality or source following the commencement of ETI therapy when compared with CON (all P > 0·05), although overall diet quality decreased between time points (P = 0·027, d = 0·57). The observed reduction in daily protein intake in the present cohort emphasises the importance of ensuring appropriate dietary protein intake to promote healthy ageing in adults with CF. More research is needed to evidence base dietary protein requirements in this at-risk population.
Diet quality has been linked to socio-economic status. However, evidence within rural and regional populations is lacking. This cross-sectional study examined the relationship between diet quality and socio-economic position in adults living in rural and regional areas of Australia. The Australian Recommended Food Score (ARFS; range 0–73) measured diet quality (total and subscale scores). Area-level socio-economic position was determined by postcode-linked socio-economic index for areas (SEIFA), Index of Relative Social Advantage and Disadvantage scores, stratified into quintiles. The mean total ARFS (34·7; sd = 9·1; n 836) was classified as ‘getting there’. Findings showed significantly lower mean total ARFS between SEIFA quintile 1 (1 = lowest; mean total ARFS = 30·4; sd = 10·2; categorised as ‘needs work’) compared with all other SEIFA quintiles (F (44 831) = 8·44, P ≤ 0·001). Linear regression, adjusting for age, sex, income, education, employment status and household composition demonstrated significantly lower overall diet quality for SEIFA quintile 1 compared with SEIFA quintile 3 (B = –3·9; 95 % CI (–6·2, −1·5); P < 0·001) and lower subscale scores for vegetables (B = –1·6; 95 % CI (–2·7, −0·6); P = 0·003), fruit (B = –0·9; 95 % CI (–1·6, −0·1); P = 0·018) and grains (B = –0·6; 95 % CI (–1·3, −0·0); P = 0·050). After adjusting for individual confounders of diet quality, results indicate that lower area-level socio-economic position remained associated with poorer diet quality in this sample of rural and regional Australian adults. This suggests that broader social and environmental factors unique to these areas may impact diet quality and amplify individual barriers to achieving a healthy diet.
What is compassion? Although a fundamental value in healthcare, this concept is often misunderstood and difficult to navigate. The authors of this book aim to answer this fundamental question, as well as offer a practical approach to how to use it in medicine. Comprised of two parts, the first part of this book explores the background to compassionate healthcare, examines how it differs from other concepts and outlines its relationship to medical professionalism. The second part offers a practical guide full of strategies and exercises to assist healthcare workers in practicing compassion by cultivating mindfulness and awareness, deepening compassion in care. This book is essential reading for medical professionals and trainees across healthcare, providing a guide to incorporating compassion into daily practice to deliver better, more compassionate care for the benefit of all. This title is also available as open access on Cambridge Core.
The radome of weather radars can be covered with a layer of water, degrading the quality of the radar products. Considering a simplified setup with a planar replica of the Swiss weather radars’ radome, we measure and model analytically its scattering parameters, with and without water. The measured reflectance of the dry radome replica agrees well with the one modeled according to the manufacturer specifications. Water forms droplets on the hydrophobic surface, but water films thicker than 1 mm can be created. Meteorologically more realistic thinner water films are expected on old radomes that have become hydrophilic with aging. Using hygroscopic silk and cotton tissues, we empirically imitate water films as thin as less than 0.1 mm. The measurements align with the simple analytical model of uniform plane wave incidence on the radome and water film but could be further improved by taking refraction and bending of the radome replica into account. Simulations with the General Reflector Antenna Software Package (GRASP) from TICRA complement the study for a representative setup with a spherical radome.
Bipolar disorders are a major cause of disability worldwide, with most of the disease burden attributed to those in low- and middle-income countries, including Nigeria. There is limited evidence on culturally appropriate interventions for bipolar disorders in Nigeria.
Aims
The study aims to examine the feasibility, and acceptability of culturally adapted psychoeducation (CaPE) for treating bipolar disorders.
Method
A randomised controlled trial (RCT) compared CaPE plus treatment as usual (TAU) with TAU alone among 34 persons with bipolar disorders in Jos, Nigeria. CaPE comprised 12 group sessions of in-person psychoeducation lasting approximately 90 min each, delivered on a weekly basis by clinical researchers supervised by clinical psychologists and consultant psychiatrists. The primary outcome was feasibility, measured by participants’ recruitment and retention rates. Other outcomes included acceptability as measured by the Service Satisfaction Scale (SSS), Brief Bipolar Disorder Symptom Scale (BBDSS), Patient Health Questionnaire (PHQ-9) and Quality-of-Life scale (EQ5D). Outcomes were assessed at baseline and weeks 12 and 24. Focus group (n = 10) and individual interviews (n = 5) were conducted with the CaPE + TAU group, recorded, transcribed verbatim and analysed using interpretative phenomenological analysis.
Results
The CaPE+TAU group (n = 17) recorded a high participant recruitment and retention rate of 86% across 12 sessions, and also recorded a higher level of satisfaction with SSS compared with the TAU alone group; 87.5% indicated very satisfied compared with 66.7% indicated not sure in the TAU group. In terms of clinical outcomes, for PHQ-9 scores the intervention group showed a reduction from baseline to end of intervention (EOI) and follow-up, with differences of −12.01 and −7.39, respectively (both P < 0.001). The EQ5D index showed a notable improvement in the intervention group at both EOI and follow-up (P < 0.001). Lastly, BBDS scores decreased significantly in the CaPE+TAU group at both EOI and follow-up, with differences of −21.45 and −15.76 (both P < 0.001).
Conclusions
The RCT of CaPE is a feasible, acceptable and culturally appropriate treatment option for bipolar disorders in Nigeria. Further adequately powered RCTs evaluating the intervention’s clinical and cost-effectiveness are warranted.
Emotional eating, the tendency to eat in response to negative emotions, is rising among adolescents and linked to obesity and mental health issues. While negative life events contribute to emotional eating, the roles of self-control and social support remain unclear.
Aims
This study examined the relationship between negative life events and emotional eating in adolescents, testing self-control as a mediator and perceived social support as a moderator.
Method
A sample of 740 Chinese high school students (aged 14–18) completed validated measures of negative life events, self-control, perceived social support, and emotional eating. Data were analyzed using SPSS 25.0 (IBM Corp., Armonk, New York, USA)and PROCESS macro for mediation/moderation effects.
Results
Negative life events predicted higher emotional eating (β = 0.11, p < 0.01), while lower self-control mediated this relationship (β = −0.15, p < 0.001). Perceived social support moderated the association (β = −0.09, p < 0.05), weakening it among adolescents with stronger support.
Conclusions
Negative life events increase emotional eating, but self-control and social support play key roles. Interventions targeting these factors may reduce emotional eating and improve adolescent well-being.
We investigated whether executive functions (EFs) are engaged in bilingual language control in Finnish speakers with different degrees of Swedish language experience and proficiency, including early bilinguals, late high-proficiency bilinguals and low-proficiency learners of Swedish. In an online experiment, language switching was measured with a cued naming (CN) paradigm, and a Simon task was used to assess EF performance. Following the skill-learning (task specificity) hypothesis, we expected that language switching may be automatized and no longer rely on EFs in bilinguals with high language proficiency, but not for those with lower proficiency. Thus, we expected significant associations between the tasks in the lower proficiency participants only. Our results showed no CN switching–EF associations in the more experienced L2 speakers, but a significant association in lower-proficiency participants. This suggests that language switching engages EFs only in participants with lower proficiency in whom these processes are not yet automatized.
Child and youth mental health is an international public health and research priority. We are an interdisciplinary and cross-sectoral network of UK-based early career researchers (ECRs) with an interest in child and youth mental health research. In this paper, we reflect on ongoing challenges and areas for growth, offering recommendations for key stakeholders in our field, including researchers, institutions and funders. We present a vision from an ECR perspective of what future child and youth mental health research could look like and we explore how the research infrastructure can support ECRs and the wider research field in making this vision a reality. We focus specifically on: (a) embracing complexity; (b) centring diverse voices; and (c) facilitating sustainable research environments and funding systems. We present recommendations for all key partners to consider alongside their local contexts and communities to actively and collaboratively drive progress and transformative change.
Rates of youth anxiety, depression, and self-harm have increased substantially in recent years. Expansion of clinical service capacity is constrained by workforce shortages and system fragmentation, and even substantial investment may not achieve the scale of growth required to address unmet need. Preventive strategies – such as strengthening social cohesion – are therefore essential to alleviate mounting pressures on the mental health system, yet their potential to compensate for these constraints remains unquantified.
Methods
This study employed a system dynamics model to explore the interplay between service capacity and social cohesion on youth mental health outcomes. The model was developed for a population catchment characterized by a mix of urban, suburban, and rural communities. Primary outcomes were prevalence of psychological distress and mental disorders, and incidence of mental health-related emergency department (ED) presentations among young people aged 15–24 years, projected over a 10-year time horizon. Two-way sensitivity analyses of services capacity and social cohesion were conducted.
Results
Changes to specialized mental health services capacity growth had the greatest projected impact on youth mental health outcomes. Heatmaps revealed thresholds where improvements in social cohesion could offset negative impacts of constrained service capacity. For example, if services capacity growth was sustained at only 80% of baseline, improving social cohesion could still reduce years lived with symptomatic disorder by 6.3%. To achieve a similar scale of improvement without improvements in social cohesion, the current growth rate in services capacity would need to be more than double. Combining a doubling of service capacity growth with reversing the decline in social cohesion could reduce ED presentations by 25.6% and years with symptomatic mental disorder by 19.2%. A doubling of specialized, headspace, and GP services capacity growth could prevent 24,060 years lived with symptomatic mental disorder among youth aged 15–24.
Conclusions
This study provides a quantitative framework for understanding how social cohesion improvements can help mitigate workforce constraints in mental health systems, demonstrating the value of integrating service expansion with social cohesion enhancement strategies.
The article examines the relationship between perceived distributive justice and trust in the welfare system within complex and self-contradictory policy setting. Based on thirty-three in-depth interviews with social assistance users in Poland and Czechia, we find that policy assemblages in those countries are experienced as confusing ‘institutional enigmas’. We identify four patterns linking perceptions of welfare system’s distributive justice and trust in this context: perceived rationality of the system combined with trust; perceived lack of system’s empathy combined with distrust; concerns about ‘undeserving claimants’ overusing the system linked to distrust in welfare system; and unexpected (non)receiving of benefits causing surprise and shaping (dis)trust. We argue that in contradictory institutional embedding, achieving users’ trust is challenging due to complex distributive justice principles they adhere to and numerous instances of those principles being violated. Trust can still be fostered when users are well informed or experience receiving meaningful support.
In the presence of fetal cardiomegaly, when there is no cardiac malformation or dysfunction, systemic or pulmonary arteriovenous malformations that may cause volume loading should be sought. We aimed to present a fetus who had cardiomegaly and left pulmonary artery-left atrial fistula and who underwent transcatheter closure in the early postnatal period.
Case presentation:
23-week fetus referred because of severe cardiomegaly on screening obstetric ultrasonography. Fetal echocardiography revealed fistulous connection between dilated left pulmonary artery and left atrium with high velocity continuous flow at the left atrial orifice of fistula and retrograde flow from the ductus arteriosus to the pulmonary artery. Initially, the fetus followed by one-to-two weeks intervals for fetal heart failure and hydrops fetalis. Pregnancy was uneventful and the baby was born by caesarean section at 37 weeks, and oxygen saturation level was 95 %. Transthoracic echocardiography confirmed the prenatal diagnosis of a fistula between the left pulmonary artery and the left atrium (CTA showed left lung aplasia. Transcatheter closure was performed from antegrade route with Amplatzer Piccolo® Duct Occluder due to hypoxaemia. The baby showed normal growth and development at 15 months of ageThere is no pulmonary hypertension during the 15-month follow-up.
Discussion:
Pulmonary artery-to-left atrial fistula is a rare anomaly and is frequently described between the right pulmonary artery and the left atrium. Presentation of age depends on the size of the fistulous connection. Patients with large connections are presented in fetal age with cardiomegaly and heart failure or presented in early infancy with profound cyanosis. Although lung hypoplasia has been reported in patients with pulmonary artery-to-left atrial fistula/connection lung aplasia has never been reported in these patients. Surgical or transcatheter closure can be achieved successfully in these patients at neonatal period or early infancy like in our case.
Neurotransmitter release via synaptic vesicle fusion with the plasma membrane is driven by SNARE proteins (Synaptobrevin, Syntaxin, and SNAP-25) and accessory proteins (Synaptotagmin, Complexin, Munc13, and Munc18). While extensively studied experimentally, the precise mechanisms and dynamics remain elusive due to spatiotemporal limitations. Molecular dynamics (MD) simulations—both all-atom (AA) and coarse-grained (CG)—bridge these gaps by capturing fusion dynamics beyond experimental resolution. This review explores the use of these simulations in understanding SNARE-mediated membrane fusion and its regulation by Synaptotagmin and Complexin. We first examine two competing hypotheses regarding the driving force of fusion: (1) SNARE zippering transducing energy through rigid juxtamembrane domains (JMDs) and (2) SNAREs generating entropic forces via flexible JMDs. Despite different origins of forces, the conserved fusion pathway – from membrane adhesion to stalk and fusion pore (FP) formation – emerges across models. We also highlight the critical role of SNARE transmembrane domains (TMDs) and their regulation by post-translational modifications like palmitoylation in fast fusion. Further, we review Ca²⁺-dependent interactions of Synaptotagmin’s C2 domains with lipids and SNAREs at the primary and tripartite interfaces, and how these interactions regulate fusion timing. Complexin’s role in clamping spontaneous fusion while facilitating evoked release via its central and accessory helices is also discussed. We present a case study leveraging AA and CG simulations to investigate ion selectivity in FPs, balancing timescale and accuracy. We conclude with the limitations in current simulations and using AI tools to construct complete fusion machinery and explore isoform-specific functions in fusion machinery.
This paper examines in what way providers of specialized Large Language Models (LLM) pre-trained and/or fine-tuned on medical data, conduct risk management, define, estimate, mitigate and monitor safety risks under the EU Medical Device Regulation (MDR). Using the example of an Artificial Intelligence (AI)-based medical device for lung cancer detection, we review the current risk management process in the MDR entailing a “forward-walking” approach for providers articulating the medical device’s clear intended use, and moving on sequentially along the definition, mitigation, and monitoring of risks. We note that the forward-walking approach clashes with the MDR requirement for articulating an intended use, as well as circumvents providers reasoning around the risks of specialised LLMs. The forward-walking approach inadvertently introduces different intended users, new hazards for risk control and use cases, producing unclear and incomplete risk management for the safety of LLMs. Our contribution is that the MDR risk management framework requires a backward-walking logic. This concept, similar to the notion of “backward-reasoning” in computer science, entails sub-goals for providers to examine a system’s intended user(s), risks of new hazards and different use cases and then reason around the task-specific options, inherent risks at scale and trade-offs for risk management.
The present paper provides a small–scale exploratory analysis of L2 English pronunciation and accent aims among secondary school students in Germany – with a focus on the bath and lot vowels, rhoticity, and T–flapping. The eight learners investigated in the current study show blended use of Standard Southern British English (StSBrE) and Standard American (StAmE) phonological variants with relatively high degrees of variation between learners. StSBrE–oriented productions were dominant overall. Agreement of accent aim and L2 pronunciation was largely feature–dependent and limited overall but varied between learners.
Participatory Design – an iterative, flexible design process that closely involves stakeholders, often end users – is growing in use across design disciplines. As more practitioners use Participatory Design (PD), it has become less rigidly defined, with stakeholders engaged to varying degrees through disjointed techniques. This ambiguity can be counterproductive when discussing PD processes. We performed a systematic literature review that builds shared, foundational knowledge of PD processes and techniques while also summarizing the state of PD research in the field, as a first step in supporting richer understandings of how best to equitably engage with stakeholders. We found that a majority of PD literature examined specific case studies of PD, with the design of intangible systems representing the most common design context. Stakeholders most often participated throughout multiple stages of a design process, recruited in a variety of ways, and engaged in several of the 14 specific participatory techniques identified. Our findings also identify leverage points for creators of PD processes and how the leverage points impact design equity, including: (1) emergent versus predetermined processes; (2) direct versus indirect participation; (3) early versus late participation; (4) one time versus iterative participation; and (5) singular versus multiple PD techniques.