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To examine whether unconscious and systemic biases regarding ethnicity have an impact on equity of access to a national tic service for children and young people (CYP) at Great Ormond Street Hospital for Children, London, UK. We retrospectively reviewed triaged referrals over an 18-month period and examined differences in triage decision, re-referrals required before acceptance and symptom severity at initial assessment by clinician-perceived and self-assigned ethnicity.
Results
There was no evidence of an unconscious bias within the triage process. CYP from racially minoritised ethnic backgrounds were underrepresented and presented with greater overall need at initial assessment.
Clinical implications
Better recording of ethnicity is a requisite starting point for research. We encourage local services to audit ethnicity of the CYP they refer to national and specialist services. Findings call for greater awareness of challenges faced by patients from racially minoritised ethnic backgrounds.
Operational roadblocks and organizational delays in multicenter clinical trials have been evident for decades, with the start-up cycle being especially notorious for setbacks. To address these challenges and improve multicenter clinical trial execution, we developed an accelerated start-up (ASU) management strategy – a structured site onboarding approach based on lean management principles.
Methods:
Three elements were integrated into the strategy: a standardized workflow, a dedicated site navigator (SN), and an electronic tracking system. We examined the range, central tendencies, and distribution of site activation times among differing combinations of these three elements. To determine how these combinations affected individual start-up milestones, we fit mixed models to compare percent achievement of predetermined milestone benchmarks and time to completion.
Results:
Thirteen consecutive trials (n = 308 site activations) employed three distinct combinations of the three ASU elements. Trials using all three elements (n = 6) had 160 total site activations in a median of 133 days. Three trials without the SN element had 52 total site activations in a median of 191 days. Four trials without the standardized workflow element had 96 total site activations in a median of 277 days. Significant differences between combinations included times to sIRB submission (p = 0.004), training/certificates completion (p = 0.03), and site activation (p = 0.003). Results suggest sites activated faster and achieved predetermined benchmarks for every milestone more often when three elements were employed.
Conclusion:
This sample trial start-up data supports that sites can meet ambitious timelines, underscoring the strategy’s potential to streamline workflows and improve site team performance.
Among the clinical features of bipolar disorder (BD), sleep disturbances are highly prevalent and persist across all phases of the illness, from onset to acute and inter-episodic periods. Substantial evidence suggests that sleep disturbances may function as proximal triggers for suicidal behavior, independent of other underlying psychiatric conditions. Although suicide is a major clinical concern in BD, the interplay between sleep disturbances and suicidality remains incompletely understood.
Methods
We conducted a systematic review and meta-analysis (SRMA) following the PRISMA guidelines. We performed a comprehensive search across PubMed, PsycINFO, and SCOPUS, including all studies reporting an association between sleep disturbances and suicidal behavior in BD. A total of 16 reports, comprising 14 cross-sectional studies and two longitudinal studies, were included in this SRMA.
Results
Among individuals with BD, sleep disturbances were associated with increased odds of lifetime suicidal behaviors (OR = 1.51, 95% CI = 1.23, 1.86), and a history of suicide attempts was associated with significantly elevated odds of experiencing sleep disturbances (OR = 1.37, 95% CI = 1.21, 1.55). In addition, poor sleep quality as measured by the Pittsburgh Sleep Quality Index positively correlated with suicidality (r = 0.24, 95% CI = 0.10, 0.36).
Conclusions
These results highlight the link between sleep disturbances and suicidal tendencies in individuals with BD. Prompt recognition and treatment of sleep disturbances could be crucial for averting or reducing suicidal behaviors in this population.
The mental health (MH) of adolescents in low- and middle-income countries (LMIC), particularly those in rural areas, has historically been neglected in research and services, despite the documented burden MH problems represent among these populations. Settings where MH stigma is high require strategic research methods. Photovoice is a promising method for MH research in contexts of high stigma, but studies examining its acceptability with rural adolescents in LMIC remain scarce. We explored the acceptability of photovoice for MH research through perspectives of adolescents from rural Mexico who participated in a photovoice project focused on factors affecting their MH. Adolescents (n = 40) participated in focus groups where they discussed what they learned through the MH photovoice project, and the aspects of the method they perceived to be valuable. Focus groups transcripts were thematically analyzed. Participants’ satisfaction with the MH photovoice project was tied to: (1) learning about the meaning, nature, and experiences of MH; (2) enjoying relationships, novelty, and fun; and (3) wishing for more time, more play, and continuity. Photovoice is an acceptable method for MH research among rural adolescents in LMIC, sparking reflection and collective dialog that can lead to the development of local initiatives.
Green transition policies set long-term targets to reduce carbon emissions and other pollutants, posing a threat to workers in polluting occupations and communities reliant on them. Can far-right parties attract voters who anticipate losing from the green transition? We explore this in Germany, which has ambitious green policies and a large workforce in polluting occupations. The far-right AfD started campaigning as the only party opposing green transition policies in 2016. Using a difference-in-differences design, we show AfD support increased more in counties with larger shares of employment in polluting occupations once the AfD adopted an anti-green platform in 2016. A panel survey demonstrates that individuals in these occupations also shifted toward the AfD. Probing mechanisms, we find that far-right support may stem from shifting perceptions of social stigma and lower status. Our results highlight the need for a new research agenda on backlash against the normative dimension of the green transition.
The treatment response for the negative symptoms of schizophrenia is not ideal, and the efficacy of antidepressant treatment remains a matter of considerable controversy. This systematic review and meta-analysis aimed to assess the efficacy of adjunctive antidepressant treatment for negative symptoms of schizophrenia under strict inclusion criteria.
Methods
A systematic literature search (PubMed/Web of Science) was conducted to identify randomized, double-blind, effect-focused trials comparing adjuvant antidepressants with placebo for the treatment of negative symptoms of schizophrenia from database establishment to April 16, 2025. Negative symptoms were examined as the primary outcome. Data were extracted from published research reports, and the overall effect size was calculated using standardized mean differences (SMD).
Results
A total of 15 articles, involving 655 patients, were included in this review. Mirtazapine (N = 2, n = 48, SMD −1.73, CI −2.60, −0.87) and duloxetine (N = 1, n = 64, SMD −1.19, CI −2.17, −0.21) showed significantly better efficacy for negative symptoms compared to placebo. In direct comparisons between antidepressants, mirtazapine showed significant differences compared to reboxetine, escitalopram, and bupropion, but there were no significant differences between other antidepressants or between antidepressants and placebo. No publication bias for the prevalence of this condition was observed.
Conclusions
These findings suggest that adjunctive use of mirtazapine and duloxetine can effectively improve the negative symptoms of schizophrenia in patients who are stably receiving antipsychotic treatment. Therefore, incorporating antidepressants into future treatment plans for negative symptoms of schizophrenia is a promising strategy that warrants further exploration.
Social relationships provide opportunities to exchange and obtain health advice. Not only close confidants may be perceived as sources of health advice, but also acquaintances met in places outside a closed circle of family and friends, e.g., in voluntary organizations. This study is the first to analyze the structure of complete health advice networks in three voluntary organizations and compare them with more commonly studied close relationships. To this end, we collected data on multiple networks and health outcomes among 143 middle-aged and older adults (mean age = 53.9 years) in three carnival clubs in Germany. Our analyses demonstrate that perceived health advice and close relationships overlap only by 34%. Moreover, recent advances in exponential random graph models (ERGMs) allow us to illustrate that the network structure of perceived health advice differs starkly from that of close relationships. For instance, we found that advice networks exhibited lower transitivity and greater segregation by gender and age in comparison to networks of close relationships. We also found that actors with poor physical health perceive less individuals as health advisors than those with good physical health. Our findings suggest that community settings, such as voluntary associations, provide a unique platform for exchanging health advice and information among both close and distant network members.
The state’s role in the perpetration or tolerance of conflict-related sexual violence (CRSV) is not inevitable, even in conflicts where the state may lack the capacity to prevent such violence or protect populations effectively. Prevention and protection by state institutions, including the military, requires reform that addresses not only CRSV behaviour and crimes but also gendered norms that condone this violence in existing legal and social frameworks of state institutions. This paper examines the development of the Joint Communiqués (JCs) as a rare example of an international-led security sector reform initiative between the UN and signatory states to implement reforms and practices to prevent CRSV. We examine the JCs signed to date with states that have militaries that have committed CRSV crimes. Our study of the JCs provides an opportunity to explore how reform to state-level institutional norms and practices proceeds in an environment with heavy dependence on the military state sector to cooperate in preventing CRSV. However, our findings call into question the conditions under which JCs should be promoted, especially when a signatory state refuses or resists including measures in JCs that address their institutional culpability for perpetrating CRSV and adopt survivor-centred gender-inclusive reforms.
The effects of high-intensity, large-scale free stream turbulence on the aerodynamic loading and boundary layer flow field development on a NACA 0018 aerofoil model were studied experimentally using direct force measurements and particle image velocimetry at a chord Reynolds number of $7\times 10^4$. An active turbulence grid was used to generate free stream turbulence intensities of up to $16\,\%$ at integral length scales of the order of the aerofoil chord length. Relative to the clean flow condition with a free stream turbulence intensity of $0.1\,\%$, elevated levels of free stream turbulence intensity decrease the lift slope at low angles of attack, and increase the stall angle and maximum lift coefficient. At moderate angles of attack, high-intensity free stream turbulence causes large variations in the location of transition, with laminar flow occasionally persisting over $90\,\%$ of the chord length. At pre-stall angles of attack, high-intensity free stream turbulence causes intermittent massive separation. Variations in the extent of turbulence in the suction surface boundary layer are linked to fluctuations in effective angle of attack, suggesting that the observed variability in transition location is related to large-scale incoming flow disturbances impinging on the aerofoil model. A comparative analysis of the present results and those in previous studies for predominantly smaller integral length scales shows the importance of both the intensity and length scale of free stream turbulence on the flow development over the aerofoil.
Flag flutter frequently features a marked difference between the onset speed of flutter and the speed below which flutter stops. The hysteresis tends to be especially large in experiments as opposed to simulations. This phenomenon has been ascribed to inherent imperfections of flatness in experimental samples, which are thought to inhibit the onset of flutter but have a lesser effect once a flag is already fluttering. In this work, we present an experimental confirmation for this explanation through motion tracking. We also visualize the wake to assess the potential contribution of discrete vortex shedding to hysteresis. We then mould our understanding of the mechanism of bistability and additional observations on flag flutter into a novel, observation-based, semiempirical model for flag flutter in the form of a single ordinary differential equation. Despite its simplicity, the model successfully reproduces key features of the physical system such as bistability, sudden transitions between non-fluttering and fluttering states, amplitude growth and frequency growth.
Despite its efficacy, little research has been conducted to evaluate the potential for electrocution to control common weeds in pastures. Electrocution could also potentially be utilized as a management tool to minimize the production of tall fescue seedheads to prevent fescue toxicosis in cattle. Separate experiments were conducted in Missouri in 2023 and 2024 to: 1) evaluate the effectiveness of electrocution on tall fescue seedhead management, and 2) evaluate forage injury and weed control following electrocution in comparison to common pre-packaged pasture herbicide combinations in mixed tall fescue and legume pastures. Sequential electrocution passes spaced 2 wk apart was the only electrocution treatment that resulted in reduced tall fescue seedhead density more than the nontreated control. However, metsulfuron-containing herbicide treatments reduced tall fescue seedhead density by 70 to 77%. In the weed control experiments, electrocution was compared to herbicide application in six mixed tall fescue and legume pastures and two johnsongrass-infested pastures in Missouri in 2023 and 2024. Most pre-packaged herbicide combinations tested eliminated white clover whereas electrocution and weed wiping had minimal effects on this species. The best electrocution treatments resulted in control of common ragweed, ironweed, common cocklebur, johnsongrass, and tall goldenrod and were comparable to that observed with the best herbicide treatments. Blackberry, sericea lespedeza and coralberry were most effectively controlled by weed wiping with glyphosate compared to all other treatments. Two passes of glyphosate with the weed wiper at 5 km/h spaced 2 wk apart providing the highest and most consistent control of johnsongrass. Results from these experiments indicate that electrocution can be used as a viable alternative to broadcast herbicide treatment for the control of several weeds that commonly occur in mixed tall fescue and legume pastures without significantly impacting forage yield or causing legume injury.
Will rising temperatures from climate change affect labour markets? This paper examines the impact of temperature on hours worked, using panel data from Peru covering the period from 2007 to 2015. We combine information on hours worked from household surveys with weather reanalysis data. Our findings show that high temperatures reduce hours worked, with the effect concentrated in informal jobs rather than in weather-exposed industries. These results suggest that labour market segmentation may shape how climate change affects labour outcomes in developing countries.
We consider numerically a Lagrangian view of turbulent mixing in two-layer stably stratified parallel shear flow. By varying the ratio of shear layer depth to density interface thickness, these flows are prone to either a primary Kelvin–Helmholtz instability (KHI) or to a primary Holmboe wave instability (HWI). These instabilities are conventionally thought to mix qualitatively differently; by vortical ‘overturning’ of the density interface induced by KHI, or by turbulent ‘scouring’ on the edges of the density interface induced by HWI. By tracking Lagrangian particles in direct numerical simulations, so that the fluid buoyancy sampled along particle paths provides a particular Lagrangian measure of mixing, we investigate the validity of this overturning/scouring classification. The timing of mixing events experienced by particles inside and outside the interface is qualitatively different in simulations exhibiting KHI and HWI. The root mean square (r.m.s.) buoyancy for particles that start with the same buoyancy is actually larger for HWI-associated flows than for KHI-associated flows for the same bulk Richardson number $Ri_b$, implying heterogeneous mixing along particle paths for HWI. The number of particles starting close to the mid-plane of the interface which experience a change in sign in the local fluid buoyancy (and hence end up on the opposite side of the mid-plane after mixing) is compared for KHI and HWI in flows with various $Ri_b$. Perhaps surprisingly, for HWI with a large $Ri_b$, more than half of the particles that start near the mid-plane end up on the opposite side of the mid-plane.
This paper describes recent developments in mental healthcare for women in Ireland and sets them in their historical context. The treatment of women’s mental health in the Republic of Ireland has evolved drastically since the 19th century, when institutions such as ‘lunatic asylums’ and Magdalene Laundries were commonplace. With deinstitutionalisation in the late 20th century, services adapted to community models, though these have remained underfunded. Recent years have witnessed dramatic developments in female-specific services and policies. Despite this progress, unmet needs remain in eating disorders, mental health support for pregnancy loss, infertility and embedding trauma-informed care.
The rise of neoliberal statism in Turkey, where the state acts as a developer in both urban and rural contexts, illuminates the multi-scalar, negotiated, and power-laden nature of frontier-making in the twenty-first century. The expansion of export-oriented sweet cherry production in western Turkey’s peri-urban landscapes exemplifies the uneven, non-linear, and contested trajectories of contemporary agrarian capitalism. This paper examines how a niche-commodity frontier is produced not only through shifts in political–economic and socio-ecological relations of production, but also through articulations of nationalism and moral authority grounded in religion. Among the various actors involved in this process, smallholders occupy a paradoxical position: structurally subordinated within export value chains yet discursively mobilized as key agents of frontier expansion. Drawing on ethnographic fieldwork, the paper argues that the ideological hegemony underpinning the frontier hinders the formation of smallholder class consciousness. Instead, the articulation of agrarian capitalism with nationalist and developmental imaginaries, expressed through the party politics of the ruling Justice and Development Party (AKP), secures widespread allegiance to Turkey’s current iteration of neoliberal development.
Written referrals and follow-up correspondence between referring general practitioners (GPs) and psychiatrists is a medico-legal responsibility and integral part of caring for patients with mental illness. Objective: To describe expectations and practices that GPs and psychiatrists have when exchanging correspondence concerning patients with mental health problems.
Methods:
In this observational, declarative, and cross-sectional study, two surveys were used to evaluate the expectations, frequency, and content of correspondence exchanged between GPs and psychiatrists. The questionnaire was based on the National College for the Quality of Psychiatric Care 2010 recommendations. Conducted in a regional setting in France between 2014 and 2016, the study involved 2754 GPs and 575 psychiatrists.
Results:
Overall, we achieved a positive response rate of 33% (189/575) of psychiatrists and 23% (628/2754) of GPs, which was similar in each local region. Regarding the correspondence from GPs to psychiatrists, 478 (75%) GPs declared having written a referral for an initial consultation and 84 (44%) psychiatrists declared having received a referral. Regarding the correspondence from psychiatrists to GPs, 144 (76%) psychiatrists declared having written at least one letter after the initial consultation or during follow-up and 160 (25%) GPs declared having received return correspondence. The GPs would like to be better informed about psychotherapeutic or long-term management, leave of absence from work, surveillance measures, prognosis, and division of specialist roles. The psychiatrists would like to receive more information about previous medication trialed, the level of willingness the patient has to consult a psychiatrist and any allergies or intolerances to medication.
Conclusion:
This study highlights the need to improve the disparity between expected and received correspondence from GPs and psychiatrists concerning patients with mental health problems.
Recently, over the course of a month in Taipei, I took in twenty-five opera performances, each opening a window onto the vast and varied world of Chinese opera.1 The performances were drawn from different genres: Peking opera (both canonical repertoire and new works), Taiwanese opera (kua-á-hì, or gezaixi), Hakka opera, Beiguan opera, Kunqu opera, Yu opera (Henan opera) and glove puppet opera (pòo-tē-hì). Although I was well aware of Taiwan’s vibrant operatic and theatrical scene – indeed, it was the very reason I pursued this residency – I was nonetheless surprised by the volume, variety and vitality of the performances I experienced. My visit coincided with one of the peak periods in the ritual calendar (the third lunar month), during which one could easily choose from more than ten outdoor opera performances each day, held at various temples throughout the greater Taipei area. In addition, meticulously crafted and lavishly mounted productions were featured at formal venues such as the Taiwan Traditional Theatre Center and Dadaocheng Theater. The performing culture of Chinese opera in Taiwan nowadays remains vibrant, imaginative, colourful and remarkably robust.
We examined cognitive performance in children with complicated mild-severe traumatic brain injury (TBI) versus orthopedic injury (OI) using the National Institutes of Health Toolbox Cognitive Battery (NIH TB-CB).
Method:
We recruited children ages 3–18, hospitalized with complicated mild-severe TBI (n = 231) or orthopedic injury (OI, n = 146). Cognition was assessed using the NIH TB-CB at six and twelve months post-injury. We used linear mixed models to assess associations of injury group (TBI versus OI), timepoint (six versus twelve months), and the interaction of injury group and timepoint with NIH TB-CB Total Cognition, Fluid Cognition, and Crystallized Cognition composites, adjusted for sex and socioeconomic status (SES), with Bonferroni correction. We evaluated differences in cognition stratified by injury severity (complicated mild–moderate TBI vs severe TBI) using ANCOVA, adjusting for sex and SES.
Results:
Neither injury group nor the interaction of group and timepoint were associated with Total (group: p = 0.50; timepoint*group: p = 0.185), Fluid (group: p = 0.297; timepoint*group: p = 0.842), or Crystallized Cognition (group: p = 0.039; timepoint*group: p = 0.017). However, children with severe TBI performed significantly worse on Fluid and Total Cognition than children with complicated mild–moderate TBI at six months (Fluid: p = 0.004, partial η2 = 0.06, moderate effect, Total: p = 0.012 partial η2 = 0.03, small–moderate effect) and twelve months post-injury (Fluid: p < 0.001, partial η2 = 0.11, moderate–large effect, Total: p = 0.002, partial η2 = 0.06, moderate effect).
Conclusions:
The NIH TB-CB detects worse cognitive functioning in children with severe TBI six-twelve months post-injury, largely driven by differences in Fluid Cognition. Our findings suggest the NIH TB-CB may be suitable for monitoring cognition in children with TBI.
This comment focuses on two intersections between private right and public right: (1) permissions to use another’s property in circumstances of necessity, and (2) distributive justice. My overall claim is that the boundaries Weinrib deftly articulates between private right and public right should not be drawn exactly as Reciprocal Freedom maintains.