Robert Simpson and Toby Handfield recently argued in this journal that my epistemic environmentalism is too radical. It implausibly collapses the distinction between rational response to evidence and group epistemic success and – on the mistaken assumption that this best conduces to epistemic success – requires uncritical deference to apparent experts. In this response, I argue that Simpson and Handfield badly mischaracterize my view. I neither collapse the distinction between ecological and epistemic rationality, nor do I countenance uncritical deference. I argue that environmentalism has the resources to give the right answers in the cases that Simpson and Handfield urge against my view.

This study evaluated how informing clinicians about Clostridioides difficile (CD) carriage affected antibiotic stewardship. A quasi-experimental pre/post design assessed antibiotic use in carriers versus non-carriers. Clinician awareness was associated with reduced antibiotic use, particularly quinolones, among carriers. Findings suggest screening and targeted education enhance stewardship and reduce high-risk antibiotic use.

The alfalfa weevil Hypera postica Gyllenhal (Coleoptera: Curculionidae) is one of the most destructive alfalfa pests in the world, resulting in substantial economic losses. However, the amount of damage can be reduced by larval parasitoids of the genus Bathyplectes Förster (Hymenoptera: Ichneumonidae) as a conservation biological control strategy. Parasitoids are currently identified by morphological body characteristics, cocoon morphology, and/or DNA analysis, but geometric morphometrics (GM) applied to the wing vein arrangement may also reveal differences between specimens. We distinguished 61 B. anurus (Thomson) and 41 B. curculionis (Thomson) specimens, based on the appearance of the cocoon. GM revealed statistically significant differences in wing vein patterns and fore wing shapes between species, but not between sexes within the same species. The 1 M + 1R1 cell, also known as the horsehead cell, was revealed to be an easy and reliable morphological character for species differentiation. Despite the New World literature, this is the first European report providing a visual method to differentiate B. anurus from B. curculionis. This study highlights the importance of precise species identification methods, such as geometric morphometry. It can contribute to a better implementation of biological control strategies against the alfalfa weevil in Spain and other Mediterranean countries.

A Rank Forum was convened to discuss the evidence around food insecurity (FIS), its impact on health, and interventions which could make a difference both at individual and societal level, with a focus on the UK. This paper summarises the proceedings and recommendations. Speakers highlighted the growing issue of FIS due to current economic and social pressures. It was clear that the health implications of FIS varied geographically since food insecure women in higher income regions tend to be living with overweight or obesity, in contrast to those living in low-to-middle income countries. This paradox could be due to stress and/or metabolic or behavioural responses to an unpredictable food supply. The gut microbiota may play a role given the negative effects of low fibre diets on bacterial diversity, species balance and chronic disease risk. Solutions to FIS involve individual behavioural change, targeted services and societal/policy change. Obesity-related services are currently difficult to access. Whilst poverty is the root cause of FIS, it cannot be solved simply by making healthy food cheaper due to various ingrained beliefs, attitudes and behaviours in target groups. Person-centred models, such as Capability-Opportunity-Motivation Behavioural Change Techniques and Elicit-Provide-Elicit communication techniques are recommended. Societal change or improved resilience through psychological support may be more equitable ways to address FIS and can combine fiscal or food environment policies to shift purchasing towards healthier foods. However, policy implementation can be slow to enact due to the need for strong evidence, consultation and political will. Eradicating FIS must involve co-creation of interventions and policies to ensure that all stakeholders reach a consensus on solutions.

Background: The complement component C5 inhibitor, ravulizumab, is approved in Canada for the treatment of adults with AQP4-Ab+ NMOSD. Updated efficacy and safety results from the ongoing CHAMPION-NMOSD (NCT04201262) trial are reported. Methods: Participants received IV-administered, weight-based dosing of ravulizumab, with loading on day 1 and maintenance doses on day 15 and every 8 weeks thereafter. Following a primary treatment period (PTP; up to 2.5 years), patients could enter a long-term extension (LTE). Outcome measures included safety, time to first adjudicated on-trial relapse (OTR), risk reduction, and disability scores. Results: 56/41 patients entered/completed the LTE as of June 14, 2024. Median follow-up was 170.3 weeks (186.6 patient-years). No patients experienced an OTR. 94.8% (55/58 patients) had stable or improved Hauser Ambulation Index scores. 89.7% (52/58 patients) had no clinically important worsening in Expanded Disability Status Scale scores. Treatment-emergent adverse events (98.4%) were predominantly mild and unrelated to ravulizumab. Serious adverse events occurred in 25.9% of patients. Two cases of meningococcal infection occurred during the PTP, and none in the LTE. One unrelated death (cardiovascular) occurred during the LTE. Conclusions: Ravulizumab demonstrated long-term clinical benefit in AQP4-Ab+ NMOSD relapse prevention while maintaining or improving disability measures, with no new safety concerns.

Obesity pathophysiological conditions and obesogenic diet compounds may influence brain function and structure and, ultimately, cognitive processes. Animal models of diet-induced obesity suggest that long-term dietary high fat and/or high sugar may compromise cognitive performance through concomitant peripheral and central disturbances. Some indicated mechanisms underlying this relationship are discussed here: adiposity, dyslipidaemia, inflammatory and oxidative status, insulin resistance, hormonal imbalance, altered gut microbiota and integrity, blood–brain barrier dysfunction, apoptosis/autophagy dysregulation, mitochondrial dysfunction, vascular disturbances, cerebral protein aggregates, impaired neuroplasticity, abnormal neuronal network activity and neuronal loss. Mechanistic insights are vital for identifying potential preventive and therapeutic targets. In this sense, flavonoids have gained attention due to their abundant presence in vegetable and other natural sources, their comparatively negligible adverse effects and their capacity to cross the blood–brain barrier promptly. In recent years, interventions with flavonoid sources have proven to be efficient in restoring cognitive impairment related to obesity. Its modulatory effects occur directly and indirectly into the brain, and three fronts of action are highlighted here: (1) restoring physiological processes altered in obesity; (2) promoting additional neuroprotection to the endogenous system; and (3) improving neuroplasticity mechanisms that improve cognitive performance itself. Therefore, flavonoid consumption is a promising alternative tool for managing brain health and obesity-related cognitive impairment.

Connectivity and trade dominate discussions of the Mediterranean Bronze and Iron Ages, where artefacts travelled increasing distances by land and sea. Much of the evidence for the means through which such networks operated is necessarily indirect, but shipwrecks offer direct insights into the movement of goods. Here, the authors explore three Iron Age cargoes recently excavated at Tel Dor on the Carmel Coast, the first from this period found in the context of an Iron Age port city in Israel. Spanning the eleventh–seventh centuries BC, these cargoes illuminate cycles of expansion and contraction in Iron Age Mediterranean connectivity and integration.

This is a short, pragmatic guide designed to assist researchers, particularly graduate students and other novice scholars, through initial stages of Japan-based study. All of the advice here is designed to help researchers address what they should do, how they should do it, and the long-term dividends they can enjoy through careful conduct in the field.