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Recent changes to US research funding are having far-reaching consequences that imperil the integrity of science and the provision of care to vulnerable populations. Resisting these changes, the BJPsych Portfolio reaffirms its commitment to publishing mental science and advancing psychiatric knowledge that improves the mental health of one and all.
Diagnosis in psychiatry faces familiar challenges. Validity and utility remain elusive, and confusion regarding the fluid and arbitrary border between mental health and illness is increasing. The mainstream strategy has been conservative and iterative, retaining current nosology until something better emerges. However, this has led to stagnation. New conceptual frameworks are urgently required to catalyze a genuine paradigm shift.
Methods
We outline candidate strategies that could pave the way for such a paradigm shift. These include the Research Domain Criteria (RDoC), the Hierarchical Taxonomy of Psychopathology (HiTOP), and Clinical Staging, which all promote a blend of dimensional and categorical approaches.
Results
These alternative still heuristic transdiagnostic models provide varying levels of clinical and research utility. RDoC was intended to provide a framework to reorient research beyond the constraints of DSM. HiTOP began as a nosology derived from statistical methods and is now pursuing clinical utility. Clinical Staging aims to both expand the scope and refine the utility of diagnosis by the inclusion of the dimension of timing. None is yet fit for purpose. Yet they are relatively complementary, and it may be possible for them to operate as an ecosystem. Time will tell whether they have the capacity singly or jointly to deliver a paradigm shift.
Conclusions
Several heuristic models have been developed that separately or synergistically build infrastructure to enable new transdiagnostic research to define the structure, development, and mechanisms of mental disorders, to guide treatment and better meet the needs of patients, policymakers, and society.
We recently reported on the radio-frequency attenuation length of cold polar ice at Summit Station, Greenland, based on bi-static radar measurements of radio-frequency bedrock echo strengths taken during the summer of 2021. Those data also allow studies of (a) the relative contributions of coherent (such as discrete internal conducting layers with sub-centimeter transverse scale) vs incoherent (e.g. bulk volumetric) scattering, (b) the magnitude of internal layer reflection coefficients, (c) limits on signal propagation velocity asymmetries (‘birefringence’) and (d) limits on signal dispersion in-ice over a bandwidth of ~100 MHz. We find that (1) attenuation lengths approach 1 km in our band, (2) after averaging 10 000 echo triggers, reflected signals observable over the thermal floor (to depths of ~1500 m) are consistent with being entirely coherent, (3) internal layer reflectivities are ≈–60$\to$–70 dB, (4) birefringent effects for vertically propagating signals are smaller by an order of magnitude relative to South Pole and (5) within our experimental limits, glacial ice is non-dispersive over the frequency band relevant for neutrino detection experiments.
This roundtable takes up old themes and new perspectives in the field of political history. Scholars engage with six questions across three main categories: the scope of the field, current debates, and teaching. The first two questions ask how we should think about political power and the boundaries of what constitute political history. The section on current debates interrogates the relationship between governing and social movements during the GAPE, and how to situate the political violence of the January 6, 2021, Capitol Hill riot in historical perspective. The final section on teaching takes up two very different challenges. One question is a perennial concern about connecting with students in the classroom about political history. The other dilemma is how to respond to the growing cascade of censorship laws passed by state legislatures that prohibit the teaching of so-called “divisive concepts.”
The Atlantic Forest of South America supports a rich terrestrial biodiversity but has been reduced to only a small extent of its original forest cover. It hosts a large number of endemic mammalian species but our knowledge of arboreal mammal ecology and conservation has been limited because of the challenges of observing arboreal species from ground level. Camera trapping has proven to be an effective tool in terrestrial mammal monitoring but the technique has rarely been used for arboreal species. For the first time in the Atlantic Forest, we obtained data on the arboreal mammal community using arboreal camera trapping, focusing on Caparaó National Park, Brazil. We placed 24 infrared camera traps in the forest canopy in seven areas within the Park, operating them continuously during January 2017–June 2019. During this period the camera traps accumulated 4,736 camera-days of footage and generated a total of 2,256 photographs and 30-s videos of vertebrates. The arboreal camera traps were able to detect arboreal mammals of a range of body sizes. The mammal assemblage comprised 15 identifiable species, including the Critically Endangered northern muriqui Brachyteles hypoxanthus and buffy-headed marmoset Callithrix flaviceps as well as other rare, nocturnal and inconspicuous species. We confirmed for the first time the occurrence of the thin-spined porcupine Chaetomys subspinosus in the Park. Species richness varied across survey areas and forest types. Our findings demonstrate the potential of arboreal camera trapping to inform conservation strategies.
This article is a clinical guide which discusses the “state-of-the-art” usage of the classic monoamine oxidase inhibitor (MAOI) antidepressants (phenelzine, tranylcypromine, and isocarboxazid) in modern psychiatric practice. The guide is for all clinicians, including those who may not be experienced MAOI prescribers. It discusses indications, drug-drug interactions, side-effect management, and the safety of various augmentation strategies. There is a clear and broad consensus (more than 70 international expert endorsers), based on 6 decades of experience, for the recommendations herein exposited. They are based on empirical evidence and expert opinion—this guide is presented as a new specialist-consensus standard. The guide provides practical clinical advice, and is the basis for the rational use of these drugs, particularly because it improves and updates knowledge, and corrects the various misconceptions that have hitherto been prominent in the literature, partly due to insufficient knowledge of pharmacology. The guide suggests that MAOIs should always be considered in cases of treatment-resistant depression (including those melancholic in nature), and prior to electroconvulsive therapy—while taking into account of patient preference. In selected cases, they may be considered earlier in the treatment algorithm than has previously been customary, and should not be regarded as drugs of last resort; they may prove decisively effective when many other treatments have failed. The guide clarifies key points on the concomitant use of incorrectly proscribed drugs such as methylphenidate and some tricyclic antidepressants. It also illustrates the straightforward “bridging” methods that may be used to transition simply and safely from other antidepressants to MAOIs.
Background: Eptinezumab is approved in the US for the preventive treatment of migraine and was well tolerated in double-blind, placebo-controlled studies in patients with episodic and chronic migraine (CM). The PREVAIL study evaluated the long-term safety, immunogenicity, and impact on patient-reported outcomes of repeat doses of eptinezumab in patients with CM. Methods: PREVAIL was an open-label, phase 3 trial comprising two 48-week treatment phases. Adults with CM received eptinezumab 300 mg by 30-minute IV every 12 weeks for ≤8 doses, with patients followed up to week 104. Results: 128 adults (mean age, 41.5y) with CM were treated. Over 2 years, the most frequently reported treatment-emergent adverse events were nasopharyngitis (14.1%), upper respiratory tract infection (7.8%), sinusitis (7.8%), influenza (6.3%), bronchitis (5.5%), and migraine (5.5%). Study-drug discontinuation due to adverse events was 6.3%. Anti-eptinezumab antibody incidence peaked at week 24 and declined despite continued dosing, to nondetectable levels at week 104. Patient-reported outcomes were improved at first assessment (week 4) and generally sustained through week 104. Conclusions: In adults with CM, eptinezumab 300 mg demonstrated a favorable safety profile, limited long-term immunogenicity, early and sustained reductions in migraine-related burden, and improvements in health-related quality of life over 2 years.
There are sparse data on the outcomes of endoscopic stapling of pharyngeal pouches. The Mersey ENT Trainee Collaborative compared regional practice against published benchmarks.
Methods
A 10-year retrospective analysis of endoscopic pharyngeal pouch surgery was conducted and practice was assessed against eight standards. Comparisons were made between results from the tertiary centre and other sites.
Results
A total of 225 procedures were performed (range of 1.2–9.2 cases per centre per year). All centres achieved 90 per cent resumption of oral intake within 2 days. All centres achieved less than 2-day hospital stays. Primary success (84 per cent (i.e. abandonment of endoscopic stapling in 16 per cent)), symptom resolution (83 per cent) and recurrence rates (13 per cent) failed to meet the standard across the non-tertiary centres.
Conclusion
Endoscopic pharyngeal pouch stapling is a procedure with a low mortality and brief in-patient stay. There was significant variance in outcomes across the region. This raises the question of whether this service should become centralised and the preserve of either tertiary centres or sub-specialist practitioners.
Mood disorders, i.e. major depressive disorder (MDD) and bipolar disorders, are leading sources of disability worldwide. Currently available treatments do not yield remission in approximately a third of patients with a mood disorder. This is in part because these treatments do not target a specific core pathology underlying these heterogeneous disorders. In recent years, abnormal inflammatory processes have been identified as putative pathophysiological mechanisms and treatment targets in mood disorders, particularly among individuals with treatment-resistant conditions.
Aims
In this selective review, we aimed to summarise recent advances in the field of immunopsychiatry, including emerging pathophysiological models and findings from treatment ttrials of immunomodulatory agents for both MDD and bipolar disorders.
Method
We performed a literature review by searching Medline for clinical trials of immunomodulating agents as monotherapy or adjunctive treatments in MDD and bipolar disorders. Included studies are randomised controlled trials (RCTs), cluster RCTs or cross-over trials of immunomodulating agents that had an active comparator or a placebo-arm.
Results
Current evidence shows an association between inflammation and mood symptoms. However, there is conflicting evidence on whether this link is causal.
Conclusions
Future studies should focus on identifying specific neurobiological underpinnings for the putative causal association between an activated inflammatory response and mood disorders. Results of these studies are needed before further treatment trials of immunomodulatory agents can be justified.
Pillared smectites in which the pillars consist of iron oxide are expected to have interesting and unusual magnetic properties. Several possible routes by which such materials might be made have been investigated, namely intercalation of hydroxy-Fe(III) polycations, mixed hydroxy-Fe(III)/Al polycations, phenanthroline-Fe(II) cations, and trinuclear Fe(III) acetato cations into Na-montmorillonite. Only the last of these yielded a pillared clay (PILC) on calcination. The products have been characterized using X-ray powder diffraction and 57Fe Mössbauer spectroscopy. The precursor Fe-PILC has a d-spacing of 21 Å and expands to 23 Å on solvation with glycol. The calcined Fe-PILC has a d-spacing of 19 Å (gallery height 9·4 Å) and does not expand with glycol, confirming cross-linking of the layers. From Mössbauer spectra at 4·2 K it is estimated that there are of the order of some hundred Fe atoms per pillar.
The crystal structure of carminite, PbFe2(AsO4)2(OH)2 has been refined. The mineral is orthorhombic, Cccm with a = 16.591(2), b = 7.580(1), c = 12.285(1) Å, Z = 8; the structure has been refined to a conventional R = 3.3% using 913 observed reflections [I>2σ(I)]. The structure contains stepped chains of edge-sharing pairs of Fe(O,OH)6 octahedra; these chains are linked by AsO4 tetrahedra and Pb atoms in distorted square antiprismatic co-ordination. The hydrogen bonding network in the structure has been modelled using bond valence calculations.
Titanomaghemite occurs in a relatively fresh doleritic intrusion in an area of Precambrian gneiss in Minas Gerais, Brazil. It hosts exsolution lamellae of ilmenite and contains more than 90% of the iron in the ferric form. It is more resistant to weathering than the ilmenite and is inherited virtually unaltered by the resulting soils. Titanomaghemite, extracted as grains from a weathered rind of the rock, has lattice parameter a0 = 0.8348(3) nm and has a canted spin structure due to substitution of non-magnetic ions on tetrahedral and octahedral sites of the spinel structure. The average canting angle is 32 ± 3° and canting occurs predominantly on the octahedral iron sublattice. Its formula, based on microprobe analysis and Mössbauer spectroscopy may be expressed as:
where [] and {} denote ions on tetrahedral and octahedral sites, respectively. The spontaneous magnetization of the mineral is 36(3) J/T/kg.
Duftite, PbCu(AsO4)(OH) is orthorhombic, space group P212121 with a = 7.768(1), b = 9. 211(1), c = 5.999(1) Å, Z = 4; the structure has been refined to R = 4.6% and Rw = 6.5% using 640 observed reflections [F> 2σ(F)]. The structure consists of chains of edge-sharing CuO6 ‘octahedra’, parallel to c; which are linked via AsO4 tetrahedra and Pb atoms in distorted square antiprismatic co-ordination to form a three dimensional network. The CuO6 ‘octahedra’ show Jahn-Teller distortion with the elongation running approximately along <627>. The hydrogen bonding network in the structure was characterized using bond valence calculations. ‘β-duftite’ is an intermediate in the duftite-conichalcite series, which has a modulated structure based on the intergrowth of the two structures in domains of approximately 50 Å. The origin of the modulation is thought to be associated with displacements in the oxygen lattice and is related to the orientation of the Jahn-Teller distortion of CuO6 ‘octahedra’. Approximately half of the strips show an elongation parallel to <627> while the other strips are elongated parallel to [010]. This ordering results in an increase in the b cell repeat compared to duftite and conichalcite.
Wycheproofite is a new hydrated sodium aluminium zirconium phosphate from a pegmatite vein in granite at Wycheproof, in northwestern Victoria, Australia. The mineral occurs as compact, finely fibrous masses in small cavities in the quartz/feldspar/muscovite/schorl-bearing pegmatite. The fibrous crystals are between 5 and 10 µm wide and up to several mm long. Accompanying minerals include two other zirconium phosphates — kosnarite and a new species, selwynite, the K-analogue of gainesite — as well as wardite, eosphorite, cyrilovite, leucophosphitc, rockbridgeite, a kidwellite-like mineral and saleeite. The wycheproofite aggregates are pale pinkish to brownish orange, with a vitreous to pearly lustre. The streak is colourless, fracture rough, cleavage not observed and the Mohs hardness is between 4 and 5. Optical data are incomplete due to the fibrous nature of the mineral; the indices of refraction are in the range 1.62–1.64. The measured density is 2.83 g cm−3. Chemical analysis gave (wt.%) Na2O 6.36, K2O 0.44, CaO 0.66, FeO 0.36, MnO 0.21, Al2O3 12.03, Cs2O 0.03, ZrO2 32.43, HfO2 1.24, P2O5 35.85, SiO2 0.23, F 0.34, H2O 9.0, less 0=F 0.14, Total 99.04. The simplified formula is NaAlZr(PO4)2(OH)2·H2O. Wycheproofite is triclinic with unit cell parameters a=10.926(5) Å, b = 10.986(5) Å, c = 12.479(9) Å, α= 71.37(4)°, β = 77.39(4)°, γ= 87.54(3)° V = 1375.9 Å3. For Z= 6, the calculated density is 2.81 g cm-3. The strongest lines in the X-ray powder diffraction pattern are [dobs (Å), Iobs,hkl] 2.603 (100) 040; 4.128 (80) 121; 3.711 (65) 023; 3.465 (60) 030; 8.865 (40) 101; 3.243 (35) 132. The crystal structure has not been solved due to the finely fibrous nature of the material available. The name is for the locality, which in the local Australian Aboriginal language means ‘witchie bushes growing on a hilltop’.
Data on the third occurrence of kosnarite, KZr2(PO4)3, at Wycheproof are also given.
Adult schistosomes live in the blood vessels and cannot easily be sampled from humans, so archived miracidia larvae hatched from eggs expelled in feces or urine are commonly used for population genetic studies. Large collections of archived miracidia on FTA cards are now available through the Schistosomiasis Collection at the Natural History Museum (SCAN). Here we describe protocols for whole genome amplification of Schistosoma mansoni and Schistosome haematobium miracidia from these cards, as well as real time PCR quantification of amplified schistosome DNA. We used microgram quantities of DNA obtained for exome capture and sequencing of single miracidia, generating dense polymorphism data across the exome. These methods will facilitate the transition from population genetics, using limited numbers of markers to population genomics using genome-wide marker information, maximising the value of collections such as SCAN.
Genetic factors may be important in the etiology of subarachnoid hemorrhage (SAH) and intracranial aneurysm (IA) formation. Several studies have reported the familial occurrence of SAH and IA, although in most cases asymptomatic family members were not studied with elective angiography. The examination of data from large sibships could provide important information about the frequency of IA occurrence in at-risk individuals and the mode of inheritance for familial SAH/1A.
Methods:
We reviewed published case series of sibships with SAH and at least four siblings, in which at least one sibling underwent elective angiography. Data were collected on age-of-onset, clinical events, presence of hypertension, angiographic findings, and outcome. Patients were classified as “affected” if they had a SAH or if an IA was detected by elective angiography, and “unaffected” if they were asymptomatic and had a negative angiogram.
Results:
Seven case series with 52 individuals (26 men and 26 women) met our inclusion criteria. The sibships ranged from 6 to 13 members. Most of the siblings (32 of 52, 61%) were asymptomatic, 18 (35%) had a SAH, and 2 (4%) had focal symptoms but no SAH. Elective angiography of 34 siblings showed an IA in 11 (32%) and was negative in 23 (68%). The overall rate of affecteds (SAH or IA) was 56%.
Conclusions:
Based on data from these sibships, angiography of asymptomatic at-risk siblings demonstrated an IA in almost one-third of cases. Familial SAH/IA segregated with a pattern that was consistent with an autosomal dominant trait in this selected series of sibships, although other factors could produce these findings.