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Involuntary placement and treatment within mental healthcare represent one of the most sensitive areas where clinical needs and human rights intersect and the protection of fundamental rights of individuals subjected to coercive measures remains a paramount concern. This issue has been along-standing interest of the European Psychiatric Association (EPA), reflected in studies conducted by the EPA members and by the EPA Code of Ethics. Moreover, the EPA supports the work of the Parliamentary Assembly of the Council of Europe on a Draft Additional Protocol to the Convention on Human Rights and Biomedicine, as an European document aiming to harmonize practice across Europe, emphasizing involuntary treatment as a last resort, guaranteeing access to legal counsel, and ensuring continuous monitoring. However, weemphasize several aspects that should be included: 1) future reforms must integrate legalsafeguards with innovations in community care and evidence-based practice, ensuring that involuntary measures remain exceptional and rigorously justified; 2) while evidence-based strategies to reduce coercive treatment exist, it is important to emphasize the need for regular staff training, knowledge exchange, and consistent application of high standards, with a focus on minimizing the use of involuntary treatment within facilities while developing alternatives; 3)coercive treatment is regularly used in general hospitals for patients lacking decision-making capacity. Addressing all involuntary treatment, in both psychiatric and other healthcare settings, to ensure that the same legal, ethical and clinical values and standards are applied to all, is also critical in order to confine coercion to the absolute minimum.
The simulation of turbulent flow requires many degrees of freedom to resolve all the relevant time and length scales. However, due to the dissipative nature of the Navier–Stokes equations, the long-term dynamics is expected to lie on a finite-dimensional invariant manifold with fewer degrees of freedom. In this study, we build low-dimensional data-driven models of pressure-driven flow through a circular pipe. We impose the ‘shift-and-reflect’ symmetry to study the system in a minimal computational cell (e.g. the smallest domain size that sustains turbulence) at a Reynolds number of 2500. We build these models by using autoencoders to parametrise the manifold coordinates and neural ordinary differential equation to describe their time evolution. Direct numerical simulations (DNSs) typically require of the order of $\mathcal{O}(10^5)$ degrees of freedom, while our data-driven framework enables the construction of models with fewer than 20 degrees of freedom. Remarkably, these reduced-order models effectively capture crucial features of the flow, including the streak breakdown. In short-time tracking, these models accurately track the true trajectory for one Lyapunov time, as well as the leading Lyapunov exponent, while at long-times, they successfully capture key aspects of the dynamics such as Reynolds stresses and energy balance. The model can quantitatively capture key characteristics of the flow, including the streak breakdown and regeneration cycle. Additionally, we report new exact coherent states found in the DNS with the aid of these low-dimensional models. This approach leads to the discovery of seventeen previously unknown solutions within the turbulent pipe flow system, notably featuring relative periodic orbits characterised by the longest reported periods for such flow conditions.
Previous research has highlighted the negative impact of the COVID-19 pandemic on healthcare workers’ (HCWs) mental health, yet protective factors remain underexplored. Emerging studies emphasize the importance of trust in government and interpersonal relationships in reducing infections and fostering positive vaccine attitudes. This study investigates the relationship between HCWs’ trust in the workplace and government and depressive symptoms during the pandemic. The COVID-19 HEalth caRe wOrkErS study surveyed 32,410 HCWs from 22 countries, including clinical and nonclinical staff. Participants completed the Patient Health Questionnaire-9 and ad-hoc questions assessing trust in the workplace and government. Logistic regression and multilevel models examined associations between trust levels and depressive symptoms. High workplace trust (OR = 0.72 [0.68, 0.76]) and government trust (OR = 0.72 [0.69, 0.76]) were linked to lower odds of depressive symptoms, with significant between-country variation. Country-level analyses showed that workplace trust was more protective in more developed countries and under stricter COVID-19 restrictions. Despite cross-country variation, HCWs with higher trust in the workplace and government had ~28% lower odds of experiencing depressive symptoms compared to those with lower trust. Promoting trust may help mitigate the mental health impact of future crises on HCWs.
To explore adults’ perceptions towards obesity and factors influencing eating behaviour and physical activity in North Lebanon, using a variation of the Photovoice method.
Design:
This research is part of a broader qualitative study exploring factors influencing the rising levels of obesity and understanding the barriers and enablers for effective policy for obesity prevention using a socio-ecological model as a guiding framework. For this study, a variation of ‘Photovoice’ was used to collect photographs to explore participants’ perspectives of obesity and its causes in Lebanon, using these photographs to generate discussion in one-to-one face-to-face interviews. Inductive and deductive thematic analyses were used to analyse the transcribed interviews.
Setting:
Tripoli, North Governorate, Lebanon.
Participants:
Twenty Lebanese adults aged 20–64 years were recruited.
Results:
The participants (n 20) generated 257 photographs representing both positive and negative influences related to food choice and physical activity, and the various factors perceived to be associated with rising obesity in Lebanon: changes in the food and eating landscape, sedentary behaviours, food environments, eating out and food marketing on social media platforms. Several themes specific to Lebanon were also identified, including the perceptions towards obesity, the central role of women in Lebanese food preparation and the family and the sociocultural importance of food and social gatherings.
Conclusions:
This study highlights how influences across the five levels of the socio-ecological model shaped the participants’ food choices and physical activity levels. Collaborative initiatives and public policies are necessary to address the identified barriers and curb the increasing prevalence of obesity in Lebanon.
To evaluate research exploring food policy, practice and provision in early childhood education and care (ECEC) settings, using the socio-ecological model (SEM).
Design:
A scoping review was conducted in accordance with the Joanna Briggs Institute (JBI) Methodology for scoping reviews and the Preferred Reporting Items for Systematic Reviews and Meta-analysis for Scoping Reviews (PRISMA-ScR). Five databases were systematically searched. Eligible studies were retrieved after full-text screening. Data were extracted and synthesised based on food policy, practice and provision concepts and grouped according to SEM level. Results were presented using a narrative summary.
Results:
Twenty-four studies were included, the majority had qualitative (n 13, 54 %) or cross-sectional study designs (n 11, 46 %) and presented findings at the organisational SEM level. Nursery settings were most represented (n 16, 67 %), followed by childminders (n 5, 21 %), then preschools (n 3, 13 %). Studies were conducted in England (n 20, 83 %) and Scotland (n 2, 8 %); however, no studies were undertaken in Wales or Northern Ireland. Studies reported poor adherence to food policies in ECEC. Recommended practices were frequently adhered to; however, food provided did not consistently meet nutritional recommendations. Common barriers to implementing healthy food practices and provision were cost, staff shortages, lack of training and awareness of available guidance.
Conclusions:
This review identified a need for research that targets a range of SEM levels and is conducted in Scotland, Wales and Northern Ireland. Our findings support the need for increased governmental support for ECEC, through food standards, free meal provision for ECEC and more accessible nutrition training.
One of the most incredible aspects of the Mexican Baja Peninsula is the immense wealth of plant and animal diversity it holds. The human communities living alongside this richness have boundless intimate knowledge of its natural history, potentially with novel insights into the ecological and evolutionary processes shaping the diversity of plants and animals. These same human communities have likely also witnessed changes to these natural environments over their lifetimes, particularly as the effects of global change are being felt by similar rural communities around the world. However, because the area is so remote, they often have little access to scientific data or current information about the causes or effects of the changes they observe. Using a thematic analysis of recorded conversations, this project seeks to connect remote rural ranches in Mexico with scientists, to gather data on the issues that matter most to the community members, and work to find collaborative solutions. Through thematic analysis of recorded conversations, our research reveals that unpredictable climate variability, including droughts, hurricanes, and shifting seasonal patterns, poses significant challenges to ranching livelihoods. Ranchers’ deep ecological knowledge provides critical insights into the stresses of changing and increasingly unpredictable environmental trends. By integrating local perspectives with scientific approaches, this study highlights the potential for collaborative biodiversity research.
The atomic bombings of Hiroshima and Nagasaki reshaped international politics and the field of International Relations. But one question—“How should the atomic bomb be used?”—has been largely overlooked in political science. This article recovers American deliberations on alternative nuclear use options before August 1945, including the “noncombat demonstration,” targeting military installations, giving advance warning, and striking more symbolically valuable cities. We develop theoretical insights on the value of staging violent spectacles and the emotive power of visible destruction. We then use a wide range of sources to show that U.S. leaders selected an ostentatiously lethal means of atomic debut due to concerns about conventional military inferiority vis-à-vis the Soviet Union, the desire to instill a widespread view of the bomb’s revolutionary character, and the imperative of shaping the postwar international order. This study advances our understanding of the post-1945 international order and the performative dimensions of political violence.
The vast presence of populism in contemporary political discourse has introduced a narrative steeped in nostalgia, evoking images of a revered national past and delineating a stark division between the ‘authentic us’ and the ‘alien them’. While these messages resonate with a substantial portion of citizens, they concurrently foster identity-driven animosity and derogation. In a pre-registered experiment in the Netherlands (with data collected between January and March 2023), we distinguish the influence of nostalgic narratives and scapegoating on societal sentiments, revealing their pivotal role in exacerbating current levels of polarization. Our findings underscore the potential of nostalgic narratives to shape affective sentiments towards ideological and social in-groups, while also influencing sentiments towards out-groups. Messages featuring scapegoats were found to intensify positive sentiment towards in-groups, while simultaneously diminishing positive sentiment towards out-groups. This research underscores a crucial mechanism underpinning the ebb and flow of identity-based sentiments. The results indicate that nostalgic discourse, particularly when intertwined with scapegoating, can serve as a catalyst for the intensification of in-group affinity and the exacerbation of out-group aversion. In essence, our study underscores the far-reaching implications of nostalgic narratives in perpetuating societal animosity and polarization and sheds light on a critical facet of contemporary political discourse.
Lesbian, gay, bisexual, transgender, queer and related community (LGBTQ+) individuals have significantly increased risk for mental health problems. However, research on inequalities in LGBTQ+ mental healthcare is limited because LGBTQ+ status is usually only contained in unstructured, free-text sections of electronic health records.
Aims
This study investigated whether natural language processing (NLP), specifically the large language model, Bi-directional Encoder Representations from Transformers (BERT), can identify LGBTQ+ status from this unstructured text in mental health records.
Method
Using electronic health records from a large mental healthcare provider in south London, UK, relevant search terms were identified and a random sample of 10 000 strings extracted. Each string contained 100 characters either side of a search term. A BERT model was trained to classify LGBTQ+ status.
Results
Among 10 000 annotations, 14% (1449) confirmed LGBTQ+ status while 86% (8551) did not. These other categories included LGBTQ+ negative status, irrelevant annotations and unclear cases. The final BERT model, tested on 2000 annotations, achieved a precision of 0.95 (95% CI 0.93–0.98), a recall of 0.93 (95% CI 0.91–0.96) and an F1 score of 0.94 (95% CI 0.92–0.97).
Conclusion
LGBTQ+ status can be determined using this NLP application with a high success rate. The NLP application produced through this work has opened up mental health records to a variety of research questions involving LGBTQ+ status, and should be explored further. Additional work should aim to extend what has been done here by developing an application that can distinguish between different LGBTQ+ groups to examine inequalities between these groups.
Loneliness is associated with several physical and mental health problems, yet its costs to the healthcare system remain unclear.
Aims
The current study aimed to review literature on the health and social care impacts of loneliness, and review economic evaluations of loneliness interventions.
Method
We conducted a systematic review of studies published from 2008 to April 2025 by searching five bibliographic databases, grey literature and reference lists of systematic reviews. Studies estimating health and social care cost/expenditure, and on health resource utilisation, were included to assess the impact of loneliness on the health system. Return on investment, social return on investment and cost-effectiveness evaluations were included to assess the economic impact of loneliness interventions. We conducted quality appraisal and narrative synthesis of results.
Results
We included 53 studies. Eight estimated the healthcare cost/expenditure of loneliness, 33 reported healthcare resource use and 19 were economic evaluations of interventions. Findings relating to the cost/expenditure of loneliness and service use were inconsistent: some studies reported excess costs/expenditure and service use, whereas others found lower costs/expenditure and service use. Economic evaluation studies indicated that loneliness interventions can be cost-effective, but were not consistently cost-saving or effective in reducing loneliness.
Conclusions
Findings on the impact of loneliness on the healthcare system and economic evaluations of loneliness interventions were varied. Therefore, we cannot derive confident conclusions from this review. To address evidence gaps, future research relating to social care, younger populations, direct healthcare costs of loneliness and randomised controlled trials with long-term follow-ups should be prioritised.
This study compares turbulent channel flows over elastic walls with those over rough walls, to explore the role of the dynamic change of shape of the wall in turbulence. The comparison is made meaningful by generating rough walls from instantaneous configurations of elastic cases. The aim of this comparison is to individually understand the role of fluid–structure interaction effects and the role of wall shape/undulations in determining the overall physics of flow near elastic walls. With an increase in the compliance of the wall, qualitatively similar trends for many of the effects produced by a rough wall are also seen in the elastic wall. However, specific features can be observed for the elastic-wall cases only, arising from the mutual interaction between the solid and fluid, leading to a further increase in drag. To understand them, we look at the turbulent structures, which exhibit clear differences across the various configurations: roughness induces only a slight reduction of streamwise coherency, resulting in a situation qualitatively similar to what is found in classical turbulent channel flows, whereas elasticity causes the emergence of a novel dominant spanwise coherency. Additionally, we explored the effect of vertical disturbances on elastic-wall dynamics by comparing with permeable walls having similar (average) wall-normal velocity fluctuations at the interface. The permeable walls were found to have minimal similarities to elastic walls. Overall, we can state that the wall motion caused by the complex fluid–structure interaction contributes significantly to the flow and must be considered when modelling it. In particular, we highlight the emergence of strong wall-normal fluctuations near the wall, which result in strong ejection events, an attribute not observed for rigid walls.
There is growing consensus on essential components of care for hospital-presenting self-harm and suicidal ideation, yet these are often inconsistently implemented. This qualitative study aimed to explore the implementation of components of care across hospitals. Interviews were conducted with health professionals providing care for self-harm and suicidal ideation in hospital emergency departments. Participants (N = 30) represented 15 hospitals and various professional roles. A framework analysis was used, where factors affecting each care component were mapped by hospital and hospital grouping.
Results
A timely, compassionate response was facilitated by collaboration between liaison psychiatry and emergency-department staff and the availability of designated space. Other factors affecting the implementation of care components included patient preferences for, and staff encouragement of, family involvement, time taken to complete written care plans and handover and availability of next care impacting follow-up of patients.
Clinical implications
The findings suggest a need for further integration of all clinical professionals on the liaison psychiatry team in implementing care for self-harm; improved systems of handover; further training and awareness on the benefits and optimal processes of family involvement; as well as enhanced access to aftercare.
It is widely believed that high inflation reduces the popularity of incumbents, and contributed to poor incumbent performance in recent elections in the United States and elsewhere. Existing research shows that voters’ inflation perceptions are associated with their evaluations of incumbent parties, but these observational studies cannot eliminate the possibility that the causal relationship runs the other way, where opposition to incumbent governments causes individuals to report higher price increases. To help overcome this inferential challenge, this study draws on a pre-registered experiment embedded in a nationally representative survey fielded just days before the 2024 US Presidential election. We find that priming Americans to think about inflation reduced support for the incumbent party. This effect is most pronounced among Independents and Democrats. These findings suggest that inflation likely contributed to the Democrats’ 2024 electoral defeat, and provide novel evidence that inflation has a causal effect on support for incumbent parties.
Twin children are more likely to die than singletons. This is an additional burden in sub-Saharan African (SSA) countries, as child mortality levels are already higher than anywhere else. This article provides estimates of under-5 mortality rates (U5MRs) for twins and singletons in SSA from 1986 to 2016. It describes the geographical variations and changes over time. It also describes the variation of twins’ excess mortality according to age from 0 to 5 years. Additionally, it analyzes the factors associated with twins’ excess mortality. We used data from 156 national surveys from 42 countries. We estimated U5MRs for twins and single children and built a Cox model to analyze factors associated with excess mortality among twins. Although child mortality has declined on the continent, twins’ excess mortality remains very high. U5MRs are, on average, 3 times higher among twins than singletons. The Cox model shows that all other things being equal, the adjusted hazard ratio of under-5 mortality (U5M) is 3.2 (2.9−3.3; p < .001) times higher among twins than singletons. The main factors associated with excess mortality risks among twins are biomedical and nutritional features, such as low birth weight, non-use of cesarean section delivery, and lack of breastfeeding. Health policy makers in SSA should be aware of the vulnerability of twins, and interventions to prevent their early deaths should be considered.
Despite growing healthcare coverage, disparities in access to and outcomes of psychiatric care persist, even in countries with universal healthcare. How socioeconomic status (SES), travel time, and social support individually and jointly affect psychiatric clinical trajectories remains largely unexplored.
Methods
We analyze electronic health records (EHRs) from patients diagnosed with bipolar disorder, major depressive disorder, or schizophrenia at Clínica San Juan de Dios Manizales. Using zero-inflated and standard negative binomial regression, we quantify the effects of SES, travel time, and family/social support on utilization, clinical outcomes, and symptoms of mania, psychosis, and suicidality. A mixed-effects model examines how care-seeking patterns affect visit-to-visit variability in outcomes.
Results
Among 21,095 patients, utilization is lower for those with low SES (rate ratio [RR] 0.92, 95% CI: 0.90–0.95, p = 1.27e−10) and longer travel times (RR 0.94, 95% CI: 0.93–0.95, p = 1.19e−53). Patients with low SES are more likely to have severe symptoms (e.g., delusions: RR 1.28, 95% CI: 1.20–1.37, p = 2.57e−15) and require hospitalization (RR 1.10, 95% CI: 1.05–1.15, p = 1.94e−04), suggesting they primarily seek care when critical. Longer travel differentially affects those with low SES. However, the relationship between SES and adverse outcomes is less pronounced when living with family (e.g., hospitalizations: LRT, χ2 = 47.08, df = 3, p = 3.35e−10). Frequent outpatient care is associated with lower odds of hospitalization, suicidality, and other symptoms.
Conclusions
Findings demonstrate use of EHRs to model patient outcomes, the important role of social support, and need for improved healthcare accessibility.
Although exposure and response prevention (EX/RP) is recommended as a first-line treatment for obsessive-compulsive disorder (OCD), responses vary among patients. This study was the first to use network analysis to examine how OCD symptom networks change with EX/RP and vary across different progress trajectories.
Methods
Data from four clinical trials with 334 adults with OCD who received manualized EX/RP were pooled. The Yale-Brown Obsessive-Compulsive Scale (Y-BOCS) was administered at baseline, midpoint, and post-treatment. OCD symptom networks were constructed using individual Y-BOCS items at these three time points, both for the entire sample and for three different progress trajectories (dramatic, moderate, and little-to-no progress) previously identified using growth mixture modeling. Network measures, including global efficiency, modularity, and weighted degree centrality, were computed to quantitatively assess network properties across treatment.
Results
Network analysis revealed two distinct modules at baseline: resistance/control and interference/distress. In the full sample, these two modules became integrated over time, as indicated by significant increases in global efficiency and weighted degree centrality and decreases in modularity; at post-treatment, the network shifted toward a fully connected network, and the strength of associations between nodes increased. These changes were most pronounced in the dramatic progress class.
Conclusions
Our findings indicated that effective EX/RP treatment was associated with more integrated OCD symptom networks, which may serve as an indicator of treatment response. Future research should examine how these shifts in network connectivity correspond to changes in underlying brain circuitry and/or to early identification of treatment responders.
Turbulence accounts for most of the energy losses associated with the pumping of fluids in pipes. Pulsatile drivings can reduce the drag and energy consumption required to supply a desired mass flux, when compared with steady driving. However, not all pulsation waveforms yield reductions. Here, we compute drag- and energy-optimal driving waveforms using direct numerical simulations and a gradient-free black-box optimisation framework. Specifically, we show that Bayesian optimisation is vastly superior to ordinary gradient-based methods in terms of computational efficiency and robustness, due to its ability to deal with noisy objective functions, as they naturally arise from the finite-time averaging of turbulent flows. We identify optimal waveforms for three Reynolds numbers and two Womersley numbers. At a Reynolds number of $8600$ and a Womersley number of 10, optimal waveforms reduce total energy consumption by 22 % and drag by 37 %. These reductions are rooted in the suppression of turbulence prior to the acceleration phase, the resulting delay in turbulence onset, and the radial localisation of turbulent kinetic energy and production towards the pipe centre. Our results pinpoint that the predominant, steady operation mode of pumping fluids through pipes is far from optimal.
With the introduction of tetflupyrolimet as the first herbicide with a novel site of action in the last three decades, screening for herbicide resistance before commercialization has become integral to ensure successful applications. In the mid-southern United States, tetflupyrolimet is anticipated to be used as a preemergence (PRE) herbicide for barnyardgrass control but does exhibit postemergence (POST) herbicidal activity. In 2020, 45 Echinochloa crus-galli (barnyardgrass) accessions were collected from rice-producing areas in Arkansas and were screened in the greenhouse to tetflupyrolimet at 134 g ai ha-1 PRE and POST at the 2- to 3-leaf growth stage on a silt loam soil. A field experiment was conducted where tetflupyrolimet was applied alone at 134 g ai ha-1 or with clomazone at 336 g ai ha-1, to a susceptible barnyardgrass standard and four other accessions with confirmed resistance to florpyrauxifen-benzyl, imazethapyr, propanil, and quinclorac at the spiking, 1-, 2-, 3-, and 4-leaf stages. For the PRE screening, the percent visible control ranged from 88% to 99%, with some accessions differing in sensitivity to tetflupyrolimet. Percent mortality ranged from 47% to 90% at the PRE timing. Visible control and mortality ranged from 63% to 88% and 7% to 65%, respectively, from a POST application, suggesting there is differential sensitivity and that foliar applications may not be as effective as soil applications. In the field experiment, barnyardgrass accession did not influence POST biomass production and was impacted more by the growth stage at application, although the difference was frequently numerical. In general, applying tetflupyrolimet alone or with clomazone to ≥3 leaf grass compromised performance. Tetflupyrolimet will be better optimized as a soil-applied herbicide in mid-southern U.S. rice culture.
Extreme precipitation events are projected to increase both in frequency and intensity due to climate change. High-resolution climate projections are essential to effectively model the convective phenomena responsible for severe precipitation and to plan any adaptation and mitigation action. Existing numerical methods struggle with either insufficient accuracy in capturing the evolution of convective dynamical systems, due to the low resolution, or are limited by the excessive computational demands required to achieve kilometre-scale resolution. To fill this gap, we propose a novel deep learning regional climate model (RCM) emulator called graph neural networks for climate downscaling (GNN4CD) to estimate high-resolution precipitation. The emulator is innovative in architecture and training strategy, using graph neural networks (GNNs) to learn the downscaling function through a novel hybrid imperfect framework. GNN4CD is initially trained to perform reanalysis to observation downscaling and then used for RCM emulation during the inference phase. The emulator is able to estimate precipitation at very high resolution both in space ($ 3 $km) and time ($ 1 $h), starting from lower-resolution atmospheric data ($ \sim 25 $km). Leveraging the flexibility of GNNs, we tested its spatial transferability in regions unseen during training. The model trained on northern Italy effectively reproduces the precipitation distribution, seasonal diurnal cycles, and spatial patterns of extreme percentiles across all of Italy. When used as an RCM emulator for the historical, mid-century, and end-of-century time slices, GNN4CD shows the remarkable ability to capture the shifts in precipitation distribution, especially in the tail, where changes are most pronounced.
Sitodiplosis mosellana (Géhin) (Diptera: Cecidomyiidae) is a significant pest of wheat, Triticum aestivum Linnaeus (Poaceae), in Canada. Monitoring currently relies on labour-intensive counts of ovipositing females. Although traps baited with S. mosellana pheromone are used as decision support tools in the United Kingdom, in Canada, they are considered reliable only to indicate adult activity. Recent findings show that variability in pheromone release from commercial lures affects the number of midges captured and limits the reliability of pheromone monitoring. Here, two lure types and two trap types were compared for their ability to attract and retain S. mosellana males. We then compared the number of males captured in pheromone traps with the information provided by other monitoring tools, including emergence traps, soil cores, and ovipositing female counts. Jackson traps with Trécé rubber septa lures captured the most midges. The number of males captured in pheromone-baited traps was not related to overwintering, ovipositing, or emerging populations, suggesting that pheromone traps may not accurately reflect S. mosellana populations under field conditions. Variability in extracted pheromone amount between lures, regional climate, and Canada’s vast wheat-growing area may limit the development of an effective pheromone-based decision support tool for this region. Nevertheless, refinement of lure formulation, standardisation of trapping protocols, and integration of complementary monitoring approaches may enhance trap reliability and support a stronger monitoring system.