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Services for people who are high users of emergency departments (EDs) have developed in a piecemeal fashion, including those embedded within liaison mental health services, over the past decade. We conducted a national survey of all 171 National Health Service hospitals in England with an ED to identify high user services, alongside 20 interviews from exemplar services to characterise the interventions offered.
Results
We had a 100% response rate. Of the 171 hospitals, 76 (44%) had a high user service in the ED without designated staff and 71 (42%) offered services with some designated staff time; 10 (6%) had community services, either separate or with hospital outreach; and 14 (8%) had no service. Interviews revealed great variability among services on most parameters, including staffing levels, entry criteria, case-load and types of intervention.
Clinical implications
There is a need for clarity on entry criteria, case-load and types of intervention, to improve consistency and effectiveness of these services to guide decision-making.
In an era of intensifying global interconnection and mounting pressure for historical reckoning, repatriation1 has emerged as a critical arena where museums navigate the fraught intersections of cultural diplomacy and sovereignty.2 Once framed primarily as a legal or ethical imperative, the restitution of cultural property now functions as a strategic site of negotiation3 that compels museums to redefine their roles within transnational networks of cultural governance. As institutions historically tasked with the stewardship of contested objects, museums today operate as diplomatic actors engaged in processes that transcend national boundaries4 and implicate broader structures of international cooperation and historical accountability, an evolution that mirrors ongoing efforts to redefine the very role of museums within global institutions such as the International Council of Museums (ICOM).5 This paper situates repatriation as a distinctly political practice, one shaped by transnational pressures, contested sovereignties, and shifting institutional roles.6 As Neil MacGregor has noted in A History of the World in 100 Objects, museums use objects to tell stories about human civilization, power, and identity; the possession and narration of those objects, then, becomes central to how institutions assert authority and interpret the nation.7
In [10], we provided a method for eliminating cuts in non-wellfounded proofs with a local-progress condition, these being the simplest kind of non-wellfounded proofs. The method consisted of splitting the proof into nicely behaved fragments. This article extends our method to proofs based on simple trace conditions. The main idea is to split the system with the trace condition into infinitely many local-progress calculi that together are equivalent to the original trace-based system. This provides a cut-elimination method using only basic tools of structural proof theory and corecursion, which is needed due to working in a non-wellfounded setting. We will employ our method to obtain syntactic cut elimination for K+, a system of modal logic with the master modality.
Plant-based diets have been associated with favourable health outcomes; however, not all plant-based diets are of the same quality. This study aimed to investigate the associations between three plant-based diet indices: overall plant-based diet index (PDI), healthy PDI (hPDI) and unhealthy PDI (uPDI) and measures of adiposity: wrist circumference, waist circumference, waist:hip ratio and BMI. This study used data from 2027 controls in the Costa Rica Heart Study, a case–control study. A validated FFQ was used to create the plant-based diet indices. Multivariable linear regression was used to examine associations between quintiles of the plant-based diet indices and adiposity indicators. Higher hPDI scores were associated with lower adiposity, with waist circumference showing the strongest association. Participants in the highest hPDI quintile had a β = −1·90 cm (95 % CI: −3·32, −0·49) lower waist circumference and a β = −0·72 kg/m2 (95 % CI: −1·33, −0·10) lower BMI compared with participants in the lowest quintile. Significant linear trends were observed with waist circumference (P-trend = 0·0037), waist:hip ratio (P-trend = 0·0064) and BMI (P-trend = 0·0171). Subjects in the 5th quintile of the overall PDI had significantly lower waist circumference (β = −1·75 cm (95 % CI: −3·14, −0·36)), waist-to-hip ratio (β = −0·010 (95 % CI: −0·019, −0·001)) and BMI (β = −0·62 kg/m2 (95 % CI: −1·22, −0·02)). In general, uPDI showed no significant associations with adiposity indicators. Among Costa Rican adults, adherence to hPDI is associated with lower adiposity, whereas uPDI showed no association, indicating the quality of plant-based diets plays a role in body composition.
This article examines the expressed neutrality of Russophones in Latvia and Estonia toward Russia’s full-scale invasion of Ukraine. Drawing on nationally representative survey data and four focus groups, the study employs a mixed-methods design to explore how individual dispositions, social contexts, and media perceptions shape neutrality. Logistic regression analysis shows that neutrality is strongly predicted by low interest in Ukrainian affairs, socioeconomic vulnerability, and—most decisively—reference group perceptions: respondents describing their milieu as neutral, mixed, or uncertain were dramatically more likely to adopt neutrality than those in pro-Ukraine circles. By contrast, opinion climate and perceived social isolation had weaker effects, while neutrality was reinforced by distrust of both Latvian and Russian media. Focus group data reveal neutrality as a negotiated stance, serving to manage social tensions and navigate contested information environments. The findings highlight neutrality as a socially embedded strategy rather than mere apathy or ignorance.
State judicial elections in the United States have become increasingly expensive, raising concerns about the influence of campaign contributions on judicial impartiality. This study examines individual donations – specifically from attorneys, non-attorneys, and business donors – in state supreme court elections from 2000 to 2023. The analysis reveals that attorneys predominantly support candidates with judicial experience and Democratic affiliation, while non-attorneys and business donors favor Republican candidates and high-profile races. These patterns underscore distinct motivations among donor groups and offer insights into the evolving dynamics of judicial campaign finance.
Music performance anxiety (MPA) is experienced widely by young musicians (DEMPSEY, E. & COMEAU, G. (2019) Music performance anxiety and self-efficacy in young musicians: Effects of gender and age. Music Performance Research, 9, 60–79.), but little is known about the role their studio teachers might play in helping them to manage it. This interview study investigates 13 studio teachers’ understanding of MPA, and their approaches to its management within the studio teaching setting. The teachers were asked about how they prepare their students for upcoming performances, MPA discussions in the teaching studio, observations of MPA symptoms, lesson elements that support MPA and training related to MPA. Four key themes were identified: conceptions of MPA, preparing for performance, managing mistakes and the teaching studio itself as a setting for MPA. The findings showed that teachers were caring, enthusiastic and often strategic in supporting MPA management, their understanding underpinned by personal perceptions of MPA. However, they also suggested aspects of their approaches that might be ambiguous or problematic: when lesson behaviours shift to prepare for imminent performances, teachers appear to both emphasise and downplay mistakes, perhaps creating confusion or lowering performance expectations. These insights suggest potential areas for further inquiry, exploring the role that studio teachers could have regarding the MPA experiences of their students.
Prenatal depression is associated with offspring behavioral problems, but heterogeneity in the strength of this association is not well understood. Maternal vitamin D concentration during pregnancy is important for fetal brain development and may help explain this variability, with potential differences by timing of exposure and maternal race.
Methods
Using data from 1,451 mother–child pairs in the Environmental influences on Child Health Outcomes cohort, linear mixed-effects models examined associations between prenatal depressive symptom severity, gestational 25-hydroxy-vitamin D (25[OH]D) concentrations, and internalizing and externalizing behaviors in preschool-aged children. Analyses were stratified by common 25(OH)D deficiency thresholds, prenatal timing, and race.
Results
Prenatal depressive symptom severity was associated with greater child internalizing (β = 0.18, 95% CI = 0.11, 0.25) and externalizing (β = 0.21, 95% CI = 0.14, 0.28) behaviors. Gestational 25(OH)D concentration did not moderate depression effect estimates in adjusted models. In stratified analyses, the association between prenatal depressive symptoms and child externalizing behaviors persisted regardless of 25(OH)D threshold levels, but the association with internalizing behaviors attenuated at 25(OH)D < 20 ng/mL. Timing of 25(OH)D measurement (early/late pregnancy) did not modify relationships. Higher gestational 25(OH)D was associated with fewer externalizing problems among offspring of Black mothers only.
Conclusions
Prenatal depressive symptoms showed robust associations with child behavioral problems, largely independent of gestational 25(OH)D. However, attenuated risk for internalizing behaviors with low vitamin D levels warrants investigation of social–environmental factors.
When a non-spherical particle sediments, its velocity generally changes in time as the particle orientation changes in time. This gives extra dispersion of the particle position in addition to the thermal Brownian motion. Brenner (J. Colloid Interf. Sci., vol. 71, 1979, pp. 189–208) studied this effect and formulated how to calculate the gravity-induced dispersion (called Taylor dispersion in sedimentation). However, he conducted the explicit calculation only for torque-free particles which keep an isotropic orientational distribution in the steady-state. In this paper, we study the effect of the gravitational torque on the Taylor dispersion. We limit the analysis to particles having uniaxial symmetry. In this case, the gravitational torque is caused by the offset $l_{{c}}$, the distance between the hydrodynamic centre and the gravitational force centre. The effect of the gravitational torque is represented by a dimensionless parameter $\alpha$ (called the Langevin parameter by Brenner) which is proportional to $l_{{c}}$. We obtain analytical expressions for the Taylor diffusivity for the two limits $\alpha \ll 1$ and $\alpha \gg 1$. We show that the offset gives a significant effect on the diffusivity and changes the classical scaling of the Taylor dispersion at a large Péclet number. We also analyse the transient regime of the mean square displacement and show how the crossing time from the ballistic regime to the diffusive regime depends on the gravitational torque.
Bishop Frank Weston’s The Black Serfs of Britain (1923) is a short pamphlet which critiques British colonial governance in East Africa in wake of the First World War. Much more difficult to obtain than its earlier sister volume, The Black Slaves of Prussia (1918), it sees Weston in a familiar combative vein. The two works are crucially important in gaining a fuller picture of Weston, his thinking and his legacy. Often remembered as an Anglo-Catholic contrarian, these political texts bring to the fore his Christian socialism and add crucial details to the journey which would famously lead to the Anglo-Catholic conference and his powerful injunction to serve Christ both in worship and social ministries. The text of The Black Serfs of Britain is printed in full with introductory material, commentary, and notes.
Human–wildlife conflicts are a growing global issue for wildlife, especially for large carnivores. The leopard Panthera pardus is generally solitary, shy and cryptic; however, human–leopard conflicts occur, including attacks on people. Attacks are generally rare throughout the majority of the species’ range, although in India they have been relatively high and are increasing. A high number of leopard attacks have been reported in the Kashmir region of India since 2000. These have been associated with the loss, fragmentation and degradation of leopard habitat as well as the scarcity of wild prey. We document leopard attacks in the Kashmir region during 2006–2023, examine causes for recent trends and discuss the challenge of coexistence. A total of 424 leopard attacks were reported, of which 312 (73.6%) resulted in injury and 112 (26.4%) in the death of the victim. The attacks were predominantly during February and September, and least during December and April. The peak number of attacks occurred during 10.00–10.59. The majority of the victims were 0–19 or 30–49 years old. Attacks by leopards were rarer than attacks by Asiatic black bears Ursus thibetanus in the same region during the same time period. However, a higher per cent of leopard attacks resulted in deaths. The number of attacks has been declining since 2009, with the exception of 2013. The reason for the decline is likely the removal of problem leopards, and the proactive measures of the Jammu and Kashmir Wildlife Protection Department and NGOs in the region.
Research consistently shows that migrants are considered less deserving of welfare than citizens, yet existing studies of this “deservingness gap” rarely account for heterogeneity within migrant populations or variation across social protection schemes. This article provides a more granular analysis of welfare deservingness by examining how migration status and scheme type jointly shape public support for migrant welfare access. Drawing on vignette experiments in Germany and the UK, we asked respondents to evaluate the deservingness of citizens and three migrant categories – those with residence permits, asylum seekers, and undocumented migrants – across four welfare schemes: unemployment benefits, emergency medical care, regular medical check-ups, and care for life-threatening illnesses. Our findings reveal substantial variation in deservingness judgments. While citizens are consistently rated as more deserving than all migrant groups, the deservingness gap varies substantially: undocumented migrants face the largest penalty, followed by asylum seekers, then migrants with residence permits. Crucially, these gaps are most pronounced for unemployment benefits but narrow considerably for healthcare services, particularly emergency and life-threatening care. We characterize these patterns as “segmented welfare chauvinism,” where public support for migrant welfare access is stratified by welfare scheme, contribution history, and legal status. These findings highlight the need for scholarship to move beyond treating “migrants” as a monolithic category and to consider how different dimensions of welfare provision activate distinct deservingness criteria.
Cette étude se concentre sur la dissidence linguistique du français mitchif, une variété en voie de disparition du français laurentien, parlée par un nombre diminuant de Métis de l’Ouest canadien. L’analyse se focalise sur l’utilisation des marqueurs de conséquence (ça) fait (que), donc, alors et so dans un corpus comprenant une cinquantaine d’entretiens recueillis au sein de la communauté métisse de Saint-Laurent, au Manitoba, durant les années 1980. Les résultats internes soutiennent l’hypothèse d’une parenté linguistique avec d’autres variétés du français laurentien. En parallèle, les données externes indiquent une nette dominance de la variante (ça) fait (que), renforçant ainsi le caractère fortement vernaculaire du français michif en comparaison avec d’autres variétés du français laurentien. Enfin, l’analyse d’extraits d’entrevues démontre que l’utilisation soutenue des variantes vernaculaires joue un rôle crucial en tant que marqueur identitaire, permettant aux locuteurs de revendiquer leur appartenance culturelle ainsi qu’une langue qu’ils perçoivent comme distincte de celle des autres francophones.
Predicting the terminus position of Greenland’s marine-terminating glaciers remains a major challenge for ice-sheet modeling. Improving model parameterizations requires understanding the dominant drivers of terminus change. Here, we employ the Liang–Kleeman information flow method to quantify the contributions of bed slope, sea-ice concentration, runoff, air temperature and ocean thermal forcing to changes in glacier terminus position and frontal ablation. We focus on three major marine-terminating glaciers, Jakobshavn Isbræ (JI), Kangerlussuaq Glacier (KG) and Helheim Glacier (HG), between 2000 and 2021. Our analysis reveals that atmospheric and oceanic forcings exert comparable influence on glacier retreat, with their causal effects demonstrating pronounced seasonal variability. These drivers dominate during the summer months while exerting minimal impact in winter. Analysis of ocean thermal forcing highlights the 0–100 m surface layer as the primary driver of terminus variability for JI and KG, underscoring the critical role of surface-ocean processes. Notably, despite theoretical relevance, bed slope at kilometer scales shows no significant causal influence, emphasizing the nonlinearity and complexity of topographic controls. Finally, we develop a parameterized statistical model that explains 53–66% of the variance in frontal ablation for the highly responsive JI and KG, but only 38% for the less sensitive HG.
To determine the frequency and nature of referrals for children with acute or chronic otorrhoea from primary care to secondary care ENT services in the UK.
Background:
Middle ear infections in children are common; if the ear drum bursts discharge leaks out (otorrhoea). This causes hearing loss during a critical developmental period. Managing these children in an appropriate time frame to prevent disease repercussions is vital. There is currently no evidence demonstrating referral patterns and management strategies across primary and secondary care services.
Method:
Children with otorrhoea were identified amongst a cohort of 2,100 paediatric ENT (age 0–16 years) referrals from primary care at two secondary care hospital trusts in England in 2023. Chi-squared statistical analysis was performed to compare referral urgency for those with or without hearing loss.
Findings:
Of the paediatric ENT referrals, 228 (10.9%) had otorrhoea (mean age: 6.4 years, female: n = 110). The most frequent symptom duration at time of referral was >3–6 months (21.1%). Children with hearing loss were not referred more urgently compared to those without reported hearing loss (28.1% vs. 29.4%, p = 0.832). Antibiotic use in primary care was predominantly using oral antibiotics compared to topical antibiotics in secondary care. This study has shown that children with otorrhoea make up a significant proportion of paediatric referrals to the ENT secondary care services in the UK. Current management is heterogenous and could contribute to treatment failure. Standardized management pathways for these patients should be formulated.
In 2025, 305 million people required humanitarian assistance, yet 75–85% of those with mental health disorders in low- and middle-income countries remain without care. While artificial intelligence (AI) is increasingly proposed to address this gap, humanitarian settings present unique challenges, including fragmented data systems, cultural and linguistic diversity and the central role of relational care. This perspective article examines the evolving AI landscape for Mental Health and Psychosocial Support (MHPSS) and introduces the “Humanitarian AI Paradox,” where widespread informal use of AI is already outpacing institutional strategy and governance. We outline four key developments shaping feasibility, including agentic AI, the emergence of an agentic workforce, the growing availability of open-weight models and the collapse of inference costs. Using the Inter-Agency Standing Committee (IASC) pyramid, we map the AI applications across four levels of care, identifying focused, non-specialised support (Level 3) as the most immediate opportunity to assist frontline workers through supervision and protocol guidance. We then examine domain-specific risks, including cultural and linguistic misinterpretation and higher operational costs for non-English languages due to token-based pricing. Finally, we propose a set of research needs necessary to support the safe, equitable and context-appropriate use of AI in humanitarian MHPSS.
The rapid advance of the digital era – characterized by big data, artificial intelligence, and platform-based ecosystems – has fundamentally reshaped the landscape for Chinese technology ventures, demanding new approaches to strategic leadership, decision-making processes, and governance. Our special issue on Chinese technology ventures addresses these three distinctive challenges in the digital era. This editorial essay of the special issue first investigates the evolution of the innovation of Chinese firms over the past five decades, highlighting the interplay between technological development and government policy in driving the emergence and growth of Chinese technology ventures. Second, by examining the organizational dynamics shaped by technology and state involvement, this paper identifies how key characteristics of the digital era affect Chinese technology ventures on strategic leadership, decision-making processes, and governance. Finally, this essay introduces the articles in this special issue and proposes avenues for future research that underscore the critical importance of understanding strategic leadership, decision-making, and governance as an integrated system within the evolving digital landscape.
Debt and mutual lending connected members of the Roman elite in the late Republic, as part of (and in tension with) the bonds of friendship and political support. This article offers a fresh approach to understanding economics in Catullus’ Carmina, arguing that the poems show a consistent attention to the ubiquity of debt in the lives of their characters. By close readings of C. 5, 23, 41 and 103, I argue that Catullus shows us the effects of economic hierarchy on amicitia, but he also depicts his own persona trapped in a mindset of acquisition, profit and loss. Rather than constructing an urbane world sealed from financial pressures, Catullus’ poetry dramatises the transformative impact of debt on lives and emotions in the 50s b.c.e.