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Here, we explore variation in a new record of archaeological house-floor sizes from the southwestern United States relative to spatially explicit time series estimates of local precipitation. Our results show that inequality becomes more severe during periods of high precipitation. This supports the theory suggesting that inequality may emerge where resources are dense, predictable, and clumped within heterogenous and circumscribed environments. Our findings indicate that wealth inequality may emerge among populations with similar subsistence adaptations as a result of local socioenvironmental variation.
Aims: Eating disorders represent a major challenge for psychiatric and broader medical care. The rate of hospitalisation has almost doubled in recent years and anorexia has a higher mortality rate than any other mental illness. Beat Eating Disorders has made recommendations for educating medical students. When making the recommendations, they did not receive responses from Cardiff or Swansea Medical Schools. This review assesses the provision of eating disorder teaching and whether it is sufficient for effective medical training.
Methods: Clinical lecturers in Cardiff and Swansea Medical School reviewed each other’s medical curricula and compared the prevalence and extent of eating disorders in each. From 1 December 2024 to 5 February 2025 we reviewed the types of learning provided, opportunities for self-directed learning, and other areas where eating disorders could arise. We compared this against the guidelines recommended by Beat for an effective curriculum. We also reviewed the schools’ official exam guidelines to assess whether eating disorders are listed as a topic in psychiatry or the broader curriculum.
Results: In Cardiff there is a dedicated lecture on eating disorders in the Year 4 psychiatry rotation, which covers all major eating disorders. There is also an optional online module written by an Eating Disorders Consultant which goes into further detail. There is no practical training in examining or communicating with a person with eating disorders.
In Swansea there was no mention of eating disorders in the curriculum yearbook. There is a lecture in Year 2 and Year 3, each an hour long. Eating disorders exist on the GMC MLA content map, so can come up in the final year OSCE (CPSA) but it is not clear whether this happens in practice in Swansea or Cardiff.
Across South Wales, clinical attachments with eating disorder services were haphazard and locality-dependent. Beat would classify both medical schools as providing “insufficient” education.
Conclusion: Medical students in Wales are not receiving education on eating disorders that satisfies the Beat recommendations. Despite achieving proficiency in academic teaching, neither medical school provides the practical experience necessary to examine, support, and treat someone with eating disorders.
Greater emphasis on eating disorders is required, not just within psychiatry, but within broader medical teaching such as cardiology and gastroenterology. Eating disorders should be better incorporated into communication stations, practical examinations, and psychiatric teaching. Better access to Eating Disorder Services for medical students would also allow them to meet patients and build vital clinical experience
Aims: Eating disorders are complex, serious illnesses that can result in physical and psychiatric co-morbidities, medical emergencies and progressive health consequences. The aim of this service evaluation was to explore current knowledge and understanding of eating disorders amongst medical students in South Wales, and evaluate current teaching and training.
Methods: Two separate cross-sectional web surveys were designed for final year medical students at Swansea and Cardiff Universities using Microsoft Forms. Participation was voluntary, and anonymised. Surveys consisted of eight Likert-based questions and one free text question, allowing participants to share personal details should they wish to participate in future data collection. The survey was disseminated via email between 7 and 14 October 2024.
Results: A total 16 final year medical students from Swansea and 21 from Cardiff completed the surveys.
Over 80% of medical students reported low confidence (rated as 5 or below /10) in their ability to describe the seven types of eating disorder. 90% of students from Cardiff and 75% of students from Swansea reported low confidence in their knowledge of the prevalence and their ability to describe a medical risk profile. 62% from Cardiff and 44% from Swansea reported low confidence in their ability to elicit symptoms of eating disorders and make diagnoses. As a result, only 38% of Cardiff students and 56% of Swansea students reported feeling confident (rated 6–10 /10) to assess the needs of patients with eating disorders and communicate with them effectively. Over 75% of the entire student cohort described low confidence in their ability to identify stages and types of management for eating disorders. Fewer than 10% of students from both Universities felt highly confident (8–10/10) that they would be able to describe medical emergencies in eating disorders.
The entire student cohort from Cardiff and over 80% of students from Swansea expressed dissatisfaction with the education and training provided on eating disorders.
Conclusion: There are significant gaps in medical students’ understanding of eating disorders and confidence in assessing and managing eating disorders is low. Eating disorders may be stigmatised, and this may introduce additional barriers to teaching and to clinical exposure.
This service evaluation highlights the need for a review of medical school curricula to confirm the provision of eating disorder teaching.
More effective and comprehensive teaching, and clinical exposure will be indicated in order to improve confidence and competence in the assessment and management of eating disorders amongst medical students before graduating.
It is now accepted that social factors affect not only onset but also mental health treatment outcomes. One such factor is financial difficulty. Within National Health Service (NHS) Talking Therapies, problem debt has been shown to interfere significantly with recovery from mental health problems, estimated as 22% versus 50% recovered with no problem debt. One solution is a combined money advice and psychological therapy intervention to improve treatment outcomes.
Aims
The aim of the current study was to trial a combined money advice and psychological therapy service within NHS Talking Therapies, to ascertain its feasibility and acceptability.
Methods
This study employed a mixed methods case series of individuals attending high-intensity cognitive–behavioural treatment who were provided with a combined intervention (money advice service plus NHS Talking Therapies). Acceptability and feasibility were evaluated through interviews, and benefit was assessed from comparisons of routinely collected symptom measures and compared to historical recovery estimates.
Results
Some 32 participants, with similar gender distribution but more representation from ethnic minorities, were recruited from NHS Talking Therapies. One-third demonstrated complete recovery on both depression and anxiety, while half showed symptom improvement and modest improvements on the financial outcomes measure. Our interviews with patients, therapists and money advisors suggested the combined intervention was acceptable and beneficial, but that money worries should be identified earlier.
Conclusions
The combined service is acceptable, accessible and could deliver benefit, even in the short term, to those with mental health and debt problems.
The Australian SKA Pathfinder (ASKAP) offers powerful new capabilities for studying the polarised and magnetised Universe at radio wavelengths. In this paper, we introduce the Polarisation Sky Survey of the Universe’s Magnetism (POSSUM), a groundbreaking survey with three primary objectives: (1) to create a comprehensive Faraday rotation measure (RM) grid of up to one million compact extragalactic sources across the southern $\sim50$% of the sky (20,630 deg$^2$); (2) to map the intrinsic polarisation and RM properties of a wide range of discrete extragalactic and Galactic objects over the same area; and (3) to contribute interferometric data with excellent surface brightness sensitivity, which can be combined with single-dish data to study the diffuse Galactic interstellar medium. Observations for the full POSSUM survey commenced in May 2023 and are expected to conclude by mid-2028. POSSUM will achieve an RM grid density of around 30–50 RMs per square degree with a median measurement uncertainty of $\sim$1 rad m$^{-2}$. The survey operates primarily over a frequency range of 800–1088 MHz, with an angular resolution of 20” and a typical RMS sensitivity in Stokes Q or U of 18 $\mu$Jy beam$^{-1}$. Additionally, the survey will be supplemented by similar observations covering 1296–1440 MHz over 38% of the sky. POSSUM will enable the discovery and detailed investigation of magnetised phenomena in a wide range of cosmic environments, including the intergalactic medium and cosmic web, galaxy clusters and groups, active galactic nuclei and radio galaxies, the Magellanic System and other nearby galaxies, galaxy halos and the circumgalactic medium, and the magnetic structure of the Milky Way across a very wide range of scales, as well as the interplay between these components. This paper reviews the current science case developed by the POSSUM Collaboration and provides an overview of POSSUM’s observations, data processing, outputs, and its complementarity with other radio and multi-wavelength surveys, including future work with the SKA.
Geophysical flows are typically composed of wave and mean motions with a wide range of overlapping temporal scales, making separation between the two types of motion in wave-resolving numerical simulations challenging. Lagrangian filtering – whereby a temporal filter is applied in the frame of the flow – is an effective way to overcome this challenge, allowing clean separation of waves from mean flow based on frequency separation in a Lagrangian frame. Previous implementations of Lagrangian filtering have used particle tracking approaches, which are subject to large memory requirements or difficulties with particle clustering. Kafiabad & Vanneste (2023, Computing Lagrangian means, J. Fluid Mech., vol. 960, A36) recently proposed a novel method for finding Lagrangian means without particle tracking by solving a set of partial differential equations alongside the governing equations of the flow. In this work, we adapt the approach of Kafiabad & Vanneste to develop a flexible, on-the-fly, partial differential equation-based method for Lagrangian filtering using arbitrary convolutional filters. We present several different wave–mean decompositions, demonstrating that our Lagrangian methods are capable of recovering a clean wave field from a nonlinear simulation of geostrophic turbulence interacting with Poincaré waves.
Borderline personality disorder (BPD) is a severe mental health condition characterized by a chronic pattern of disturbed interpersonal function, affective instability, impulsive behavior, and an unstable sense of self. BPD has considerable public health importance due to its high burden on patients, families, and health care systems. Common in the general population, BPD is highly prevalent in psychiatric settings. It emerges from the interactions between biological (e.g., genetics, neurobiology, and temperament) and environmental factors (e.g., maltreatment and inadequate support). During adolescence, BPD can be differentiated from other psychopathology as a coherent clinical entity. Longitudinal studies have shown that symptomatic remission is common, although functional recovery is less frequent. Specialized psychotherapies, such as dialectical behavior therapy (DBT) and mentalization-based treatment (MBT), are considered the first line of treatment. Generalist approaches, such as good psychiatric management (GPM), have also been found effective. Given that specialized treatment availability is limited, and most clinicians will encounter patients with BPD due to its prevalence, it is critical that generalist clinicians learn how to manage BPD effectively.
This chapter investigates the reception of Lucian in Voltaire’s works and Giacomo Leopardi’s Operette morali. I argue that Lucian’s contamination of codified genres, especially clear in his Prometheus es in verbis, into a new satirical genre provided the two modern authors with a useful tool to innovate the literary conventions of their times and to create a hybrid, polemical, humorous prose – a previously uncanonised form of philosophical critique. Voltaire is influenced, directly and indirectly, by Lucian not only in his dialogues, but also in the creation of his conte philosophique as a form of mélange and in the use of defamiliarising devices such as cosmic travel and the dialogue of the dead. In Leopardi’s works, where Lucian is the most present ancient author and his influence is openly acknowledged, the imitation of Lucian is clearly part of a global effort by Leopardi to reform Italian culture and its literary conventions. Nevertheless, together with the problematic status of Lucian, the canonical status and literary reception of Voltaire and Leopardi in their national cultures helped eclipse Lucian’s model, as the two modern authors took his place in exerting their influence, while absorbing and innovating on Lucian’s hybridised writing.
This is my last Shakespeare review for this journal, and a good thing too. Most of the Shakespeare productions I saw this year were really adaptations. Almost all were ‘presentist’. This does not mean that I didn’t enjoy many of them, just that my particular kind of expertise was largely useless: their ideal reviewer would be a social historian or an expert on popular culture. Because the collective tendency seemed to me significant, I am covering more productions than usual, and, because they were dominated by a directorial vision, I am naming only directors. This is of course unfair to the actors, but the abundance of online reviews means that anyone can supplement my accounts. Directors often seemed to rely on their audience’s previous experience or expectations of the plays, which is presumably why they mostly confined themselves to the same small group that everyone already knows.
This introduction presents the structure and contents of the current issue of Archaeological Reports. It also offers an overview (not meant to be exhaustive) of archaeological activity in Greece over the past 12 months, focusing on major exhibitions and other cultural events as well as on important recent publications.
This project aims to increase confidence among Liaison Psychiatrists (LPs) in North East London Foundation Trust (NELFT) regarding their adherence to the prescribing guidelines for antidepressants by 25% in accordance with the standard set by Psychiatric Liaison Accreditation Network (PLAN).
Background The prescribing guidelines in this project are based on Standard 21 from 7th Edition Standards as devised by PLAN which states:
“When medication is prescribed, specific treatment goals are set with the patient, the risks (including interactions) and benefits are discussed, a timescale for response is set and patient consent is recorded.”
This project focuses on antidepressants because they are one of the widely used medications in psychiatry that doctors of all grades working in Liaison Psychiatry will be familiar with to some extent. Adhering to this validated guideline would promote gaining informed consent and patients’ involvement in their care, which studies have shown can increase adherence to treatment.
Methods
Circulated an eight-question survey by email based on Standard 21 of 7th Edition Standards document by PLAN to LPs in NELFT. Conducted two Plan-Do-Study-Act (PDSA) cycles. The first PDSA uses a teaching session as the intervention and explained the importance of antidepressant guidelines and what areas LPs need to address with patients. The second intervention uses a poster to reinforce the key points. After each intervention a reissued survey assesses the change in responses.
Results
The baseline survey response rate was 10 out of 15 LPs, made up of seven consultants, two registrars and one foundation year doctor. The lowest levels of confidence were reported around providing patients with printed information on their prescribed antidepressant with the majority of consultants reporting the lowest level of confidence. The highest levels of confidence across all medical grades were reported around discussing a specific treatment goal and explaining the benefits of treatment with antidepressant medication.
Conclusion
From the baseline data, it can be concluded that providing patients with printed information on newly prescribed antidepressants is the area that LPs, particularly consultants, are the least confident about regarding their adherence to prescribing guidelines. Future cycles of this quality improvement project can assess how incorporating teaching on antidepressant prescribing guidelines into trust induction sessions impacts LPs confidence in their adherence.
The project aims to improve carers’ engagement for patients admitted to our male Psychiatric Intensive Care Unit by improving communication between staff and carers; and by involving carers more in patients’ care.
Hypothesis:
Among patients admitted to PICU, there is inconsistency in communication with carers and in involving carers in patients’ care. We expect an improvement in these parameters with the quality improvement project.
Background:
Within PICUs, patients with severe psychiatric illness face social isolation. Challenges arise when carers are not engaged, impeding patient support and personalised care. Involving carers becomes crucial for informed decision-making, ensuring both patients and carers actively participate in the care process. National Association of PICUs and The Royal College of Psychiatrists' Guidance for PICU sets out recommendations regarding timelines and types of interventions to be offered to carers.
Methods
Initial baseline data was collected by reviewing patient electronic notes.
We then tested interventions to improve carers’ engagement by using the Plan-Do-Study-Act (PDSA) methodology over 2 cycles. In the first cycle, we engaged the nursing staff by presenting the baseline data and recommendations to improve carers’ engagement. In the second cycle, we introduced an admission protocol to ensure carers were engaged consistently. The parameters assessed were documentation of carers details; contacting carers within 24 hours of admission; documenting carers' views in care plan; inviting carers to Care Plan Approach (CPA) meetings and offer an appointment for carers with staff.
Data was collected after each PDSA cycle to monitor change.
Results
Of the patients admitted to PICU, 29% had their carers’ details documented at baseline, 40% after the first PDSA and 80% after the second PDSA. 42% of carers were contacted within 24 hours of admission at baseline; 66% and 30% after the two PDSA. 50% of carers had their views included in the care plan at baseline; 0% and 30% after the interventions. At baseline, 42% of patients’ carers were invited to the CPA meeting, 66% and 30% after the two PDSA cycles. 50% of patients’ carers were offered an appointment with staff at baseline, 66% and 30% after the two interventions.
Conclusion
As a result of this quality improvement project there has been an improvement in engaging carers of patients admitted to PICU. This was not sustained for the second cycle due to many regular senior staff being on leave during Christmas. The next steps will be to implement this consistently and produce a carers’ information pack.
Clusters of galaxies have been found to host Mpc-scale diffuse, non-thermal radio emission in the form of central radio halos and peripheral relics. Turbulence and shock-related processes in the intra-cluster medium are generally considered responsible for the emission, though details of these processes are still not clear. The low surface brightness makes detection of the emission a challenge, but with recent surveys with high-sensitivity radio telescopes we are beginning to build large samples of these sources. The Evolutionary Map of the Universe (EMU) is a Southern Sky survey being performed by the Australian SKA Pathfinder (ASKAP) over the next few years and is well-suited to detect and characterise such emission. To assess prospects of the full survey, we have performed a pilot search of diffuse sources in 71 clusters from the Planck Sunyaev–Zeldovich (SZ) cluster catalogue (PSZ2) found in archival ASKAP observations. After re-imaging the archival data and performing both (u, v)-plane and image-plane angular scale filtering, we detect 21 radio halos (12 for the first time, excluding an additional six candidates), 11 relics (in seven clusters, and six for the first time, excluding a further five candidate relics), along with 12 other, unclassified diffuse radio sources. From these detections, we predict the full EMU survey will uncover up to $\approx 254$ radio halos and $\approx 85$ radio relics in the 858 PSZ2 clusters that will be covered by EMU. The percentage of clusters found to host diffuse emission in this work is similar to the number reported in recent cluster surveys with the LOw Frequency ARray (LOFAR) Two-metre Sky Survey [Botteon, et al. 2022a, A&A, 660, A78], suggesting EMU will complement similar searches being performed in the Northern Sky and provide us with statistically significant samples of halos and relics at the completion of the full survey. This work presents the first step towards large samples of the diffuse radio sources in Southern Sky clusters with ASKAP and eventually the SKA.
Niemann-Pick Type C (NPC) is a genetic neurodegenerative lysosomal storage disorder commonly associated with psychiatric symptoms and delays to accurate diagnosis and treatment. This study investigated biomarker levels and diagnostic utility of plasma neurofilament light chain (NfL) and glial fibrillary acidic protein (GFAP) in NPC compared to healthy controls.
Methods:
Patients with NPC were recruited from a specialist assessment and management service. Data was available from an age and sex-matched healthy control group. NfL and GFAP were measured on Quanterix Simoa HD-X analysers and groups compared using generalised linear models. NfL levels were compared to, and percentiles derived from, recently developed NfL reference ranges.
Results:
Plasma NfL was significantly elevated in 11 patients with NPC compared to 25 controls (mean 17.1 vs. 7.4 pg/ml, p < 0.001), and reference ranges (all >98th percentile). NfL distinguished NPC from controls with high accuracy. GFAP levels were not elevated in NPC (66.6 vs. 75.1 pg/ml).
Discussion:
The study adds important evidence on the potential diagnostic utility of plasma NfL in NPC, extends the literature of NfL as a diagnostic tool to differentiate neurodegenerative from primary psychiatric disorders, and adds support to the pathology in NPC primarily involving neuronal, particularly axonal, degeneration.
Building upon existing research conducted in face-to-face universities, our research explored whether, in the context of a distance learning institution, the positive association between subjective socioeconomic status and academic performance can be explained by students’ sense of belonging. To that end, we conducted a three-wave correlational study with 2,261 students enrolled in Social Psychology in a distance learning university. At the start of the academic year, we measured participants’ subjective socioeconomic status relative to other students alongside their initial expectations in terms of time investment and grades and other relevant covariates. Midway through the course, we assessed their sense of belonging to the university and, at the end, we recorded their grades. Results suggested that sense of belonging potentially serves as a mediating factor in the positive relationship between subjective socioeconomic status and grades even after accounting for variables like initial grade expectations, time commitment, gender, age, and employment situation. These findings emphasize the pivotal role of students’ psychological connection to the university in shaping their academic achievement, even within the expanding landscape of distance education.
Cognitive remediation (CR) can reduce the cognitive difficulties experienced by people with psychosis. Adapting CR to be delivered remotely provides new opportunities for extending its use. However, doing so requires further evaluation of its acceptability from service users’ views. We evaluate the acceptability of therapist-supported remote CR from the perspectives of service users using participatory service user-centred methods.
Method:
After receiving 12 weeks of therapist-supported remote CR, service users were interviewed by a service user researcher following a semi-structured 18-question interview guide. Transcripts were analysed using reflexive thematic analysis with themes and codes further validated by a Lived Experience Advisory Panel and member checking.
Results:
The study recruited 26 participants, almost all of whom reported high acceptability of remote CR, and some suggested improvements. Four themes emerged: (1) perceived treatment benefits, (2) remote versus in-person therapy, (3) the therapist’s role, and (4) how it could be better.
Conclusions:
This study used comprehensive service user involvement methods. For some participants, technology use remained a challenge and addressing these difficulties detracted from the therapy experience. These outcomes align with existing research on remote therapy, suggesting that remote CR can expand choice and improve access to treatment for psychosis service users once barriers are addressed. Future use of remote CR should consider technology training and equipment provision to facilitate therapy for service users and therapists.
For the first time, this book offers qualitative research on the lives and social relationships of older imprisoned women. In-depth interviews with twenty-nine female prisoners in the south-eastern United States show that older women both engage in generative behaviours, or 'giving back', in prison and also wish to do so upon their release.
Neuropsychological criteria for mild cognitive impairment (MCI) more accurately predict progression to Alzheimer’s disease (AD) and are more strongly associated with AD biomarkers and neuroimaging profiles than ADNI criteria. However, research to date has been conducted in relatively healthy samples with few comorbidities. Given that history of traumatic brain injury (TBI) and post-traumatic stress disorder (PTSD) are risk factors for AD and common in Veterans, we compared neuropsychological, typical (Petersen/Winblad), and ADNI criteria for MCI in Vietnam-era Veterans with histories of TBI or PTSD.
Method:
267 Veterans (mean age = 69.8) from the DOD-ADNI study were evaluated for MCI using neuropsychological, typical, and ADNI criteria. Linear regressions adjusting for age and education assessed associations between MCI status and AD biomarker levels (cerebrospinal fluid [CSF] p-tau181, t-tau, and Aβ42) by diagnostic criteria. Logistic regressions adjusting for age and education assessed the effects of TBI severity and PTSD symptom severity simultaneously on MCI classification by each criteria.
Results:
Agreement between criteria was poor. Neuropsychological criteria identified more Veterans with MCI than typical or ADNI criteria, and were associated with higher CSF p-tau181 and t-tau. Typical and ADNI criteria were not associated with CSF biomarkers. PTSD symptom severity predicted MCI diagnosis by neuropsychological and ADNI criteria. History of moderate/severe TBI predicted MCI by typical and ADNI criteria.
Conclusions:
MCI diagnosis using sensitive neuropsychological criteria is more strongly associated with AD biomarkers than conventional diagnostic methods. MCI diagnostics in Veterans would benefit from incorporation of comprehensive neuropsychological methods and consideration of the impact of PTSD.
This article revisits ‘the problem of Classical Ionia’, the long-persisting idea put forward by John Manuel Cook in 1961 that Ionia experienced regional economic impoverishment in the fifth century BCE. By looking comprehensively at the dataset of coinage available from fifth-century Ionia, this article argues that there is actually significant evidence for regional networking in Classical Ionia, and that various communities, even if not continually emitting new coinages at all points in the fifth century, adopted various strategies for maintaining their economic reach and extending their network of trading partners. Formal network analysis is applied to the coinage dataset, taking the shared weight standards to which communities minted their coins as indicative of participation in common economic networks. The network patterns are tested against two other patterns, specifically the distribution of fifth-century Chian and Samian amphoras, and the pattern of Ionian-coin-containing hoards from within and beyond Ionia. Together, these patterns strengthen the case for a high-level Ionian economic resilience, offering a radically different position to Cook and reaffirming that continuing economic networking was crucial to the activities of fifth-century Ionian states.