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Functional impairment in daily activities, such as work and socializing, is part of the diagnostic criteria for major depressive disorder and most anxiety disorders. Despite evidence that symptom severity and functional impairment are partially distinct, functional impairment is often overlooked. To assess whether functional impairment captures diagnostically relevant genetic liability beyond that of symptoms, we aimed to estimate the heritability of, and genetic correlations between, key measures of current depression symptoms, anxiety symptoms, and functional impairment.
Methods
In 17,130 individuals with lifetime depression or anxiety from the Genetic Links to Anxiety and Depression (GLAD) Study, we analyzed total scores from the Patient Health Questionnaire-9 (depression symptoms), Generalized Anxiety Disorder-7 (anxiety symptoms), and Work and Social Adjustment Scale (functional impairment). Genome-wide association analyses were performed with REGENIE. Heritability was estimated using GCTA-GREML and genetic correlations with bivariate-GREML.
Results
The phenotypic correlations were moderate across the three measures (Pearson’s r = 0.50–0.69). All three scales were found to be under low but significant genetic influence (single-nucleotide polymorphism-based heritability [h2SNP] = 0.11–0.19) with high genetic correlations between them (rg = 0.79–0.87).
Conclusions
Among individuals with lifetime depression or anxiety from the GLAD Study, the genetic variants that underlie symptom severity largely overlap with those influencing functional impairment. This suggests that self-reported functional impairment, while clinically relevant for diagnosis and treatment outcomes, does not reflect substantial additional genetic liability beyond that captured by symptom-based measures of depression or anxiety.
As temperatures globally continue to rise, sporting events such as marathons will take place on warmer days, increasing the risk of exertional heat stroke (EHS).
Methods
The medical librarian developed and executed comprehensive searches in Ovid MEDLINE, Ovid Embase, CINAHL, SPORTDiscus, Scopus, and Web of Science Core Collection. Relevant keywords were selected. The results underwent title, abstract, and full text screening in a web-based tool called Covidence, and were analyzed for pertinent data.
Results
A total of 3918 results were retrieved. After duplicate removal and title, abstract, and full text screening, 38 articles remained for inclusion. There were 22 case reports, 12 retrospective reviews, and 4 prospective observational studies. The races included half marathons, marathons, and other long distances. In the case reports and retrospective reviews, the mean environmental temperatures were 21.3°C and 19.8°C, respectively. Discussions emphasized that increasing environmental temperatures result in higher incidences of EHS.
Conclusion
With rising global temperatures from climate change, athletes are at higher risk of EHS. Early ice water immersion is the best treatment for EHS. Earlier start times and cooling stations for races may mitigate incidences of EHS. Future work needs to concentrate on the establishment of EHS prevention and mitigation protocols.
This collection gathers thirteen contributions by a number of historians, friends, colleagues and/or students of Jinty’s, who were asked to pick their favourite article by her and say a few words about it for an event held in her memory on 15 January 2025 at King’s College London. We offer this collection in print now for a wider audience not so much because it has any claim to be exhaustive or authoritative, but because taken all together these pieces seemed to add up to a useful retrospective on Jinty’s work, its wider context, and its impact on the field over the decades. We hope that, for those who know her work well already, this may be an opportunity to remember some of her classic (and a few less classic) articles, while at the same time serving as an accessible introduction to her research for anyone who knew her without necessarily knowing about her field, as well as for a new and younger generation of readers.
CBRN incidents require specialized hazmat decontamination protocols to prevent secondary contamination and systemic toxicity. While wet decontamination is standard, it can present challenges in cold weather or when resources are limited. Dry decontamination offers an alternative and supportive approach, though its effectiveness across different contaminants remains unclear. This scoping review evaluates the effectiveness, advantages, and limitations of dry decontamination in hazmat incidents.
Methods
A scoping review was conducted using MEDLINE, CINAHL, and other databases. Following the PRISMA-ScR approach, 9 studies were selected from 234 identified articles. The review assessed decontamination techniques, materials, and effectiveness across different contaminants.
Results
Dry decontamination is rapid, resource-efficient, and suitable for immediate use in pre-hospital and hospital settings, especially during mass casualty incidents (MCIs). Dry decontamination is highly effective for liquid contaminants, with blue roll and sterile trauma dressings removing over 80% of contaminants within minutes. However, dry decontamination is less effective for hair and particulate contaminants. Blotting and rubbing techniques significantly enhance decontamination efficiency.
Conclusions
Dry decontamination can be an effective alternative for wet decontamination, particularly for liquid contaminants, as a first-line approach for scenarios where wet decontamination is not a practical solution for logistical and environmental reasons. However, dry decontamination is less effective than wet decontamination for hair and particulate contaminants. Combining dry and wet decontamination is shown to be more effective. Identifying the need for including dry decontamination as an integral part of the CBRN response plan improves the efficacy of decontamination.
Aims: Safe and effective prescribing in people living with dementia (PLWD) is particularly challenging due to the increased risk of adverse events, polypharmacy and potentially inappropriate medications. Cognitive impairment and reliance on caregivers to report symptoms can further complicate the assessment of drug benefits. This case study demonstrates how novel contactless monitoring could address these challenges by enabling remote evaluation of drug effects in PLWD.
Methods: We present the case of a 77-year-old gentleman with late onset Alzheimer’s disease enrolled on the CR&T MINDER cohort study and continuously monitored using the Withing’s Sleep Analyzer. He visited his GP with complaints of insomnia and was subsequently prescribed 15 mg of mirtazapine. He reported immediate beneficial effects, although noted that the drug made him drowsy. We evaluated his sleep by comparing baseline sleep metrics (a 2-week average 1 month before drug administration) with average sleep metrics 2 weeks after starting mirtazapine. Statistical analysis was performed using a paired t-test and a rolling average to assess trends over time.
Results: Calculated rolling average showed reductions in time spent awake overnight and in light sleep, while deep sleep and total sleep time increased. These trends were confirmed by period comparisons. Baseline deep sleep duration (M = 1.19 hrs, SD = 1.02 hrs), and total sleep time (M = 7.16 hrs, SD = 1.03 hrs) significantly increased 2 weeks post mirtazapine (deep sleep: M = 2.63 hrs, SD = 1.03 hrs); total sleep time: M = 7.87 hrs, SD = 0.47 hrs), t(13) = −3.639, p = 0.003, and t(13) = −2.256, p = 0.042. There was also a significant reduction in time spent awake during the night from baseline (M = 1.17 hrs, SD = 0.51 hrs) to 2 weeks post mirtazapine (M = 0.65 hrs, SD = 0.43 hrs), t(13) = 2.616, p = 0.0214.
Conclusion: This case study shows that contactless remote monitoring could be used objectively to evaluate the effects of mirtazapine on sleep in PLWD. Our results demonstrate that improvements in sleep detected by monitoring align with the participants’ reported benefits. These findings suggests continuous remote monitoring could provide valuable, timely insights into drug effects in PLWD, improving clinical decision-making and personalising care.
We present the Evolutionary Map of the Universe (EMU) survey conducted with the Australian Square Kilometre Array Pathfinder (ASKAP). EMU aims to deliver the touchstone radio atlas of the southern hemisphere. We introduce EMU and review its science drivers and key science goals, updated and tailored to the current ASKAP five-year survey plan. The development of the survey strategy and planned sky coverage is presented, along with the operational aspects of the survey and associated data analysis, together with a selection of diagnostics demonstrating the imaging quality and data characteristics. We give a general description of the value-added data pipeline and data products before concluding with a discussion of links to other surveys and projects and an outline of EMU’s legacy value.
It remains unclear which individuals with subthreshold depression benefit most from psychological intervention, and what long-term effects this has on symptom deterioration, response and remission.
Aims
To synthesise psychological intervention benefits in adults with subthreshold depression up to 2 years, and explore participant-level effect-modifiers.
Method
Randomised trials comparing psychological intervention with inactive control were identified via systematic search. Authors were contacted to obtain individual participant data (IPD), analysed using Bayesian one-stage meta-analysis. Treatment–covariate interactions were added to examine moderators. Hierarchical-additive models were used to explore treatment benefits conditional on baseline Patient Health Questionnaire 9 (PHQ-9) values.
Results
IPD of 10 671 individuals (50 studies) could be included. We found significant effects on depressive symptom severity up to 12 months (standardised mean-difference [s.m.d.] = −0.48 to −0.27). Effects could not be ascertained up to 24 months (s.m.d. = −0.18). Similar findings emerged for 50% symptom reduction (relative risk = 1.27–2.79), reliable improvement (relative risk = 1.38–3.17), deterioration (relative risk = 0.67–0.54) and close-to-symptom-free status (relative risk = 1.41–2.80). Among participant-level moderators, only initial depression and anxiety severity were highly credible (P > 0.99). Predicted treatment benefits decreased with lower symptom severity but remained minimally important even for very mild symptoms (s.m.d. = −0.33 for PHQ-9 = 5).
Conclusions
Psychological intervention reduces the symptom burden in individuals with subthreshold depression up to 1 year, and protects against symptom deterioration. Benefits up to 2 years are less certain. We find strong support for intervention in subthreshold depression, particularly with PHQ-9 scores ≥ 10. For very mild symptoms, scalable treatments could be an attractive option.
Film offers untapped potential for making critical interventions in world politics, particularly in ways that harness people’s capacity to narrate stories that creatively empower their communities. Combining International Relations scholarship on visual politics with narrative theory and feminist scholarship on care, this paper presents film as a means of exploring and expressing narrative agency; that is, the power to tell stories that represent people’s experiences in ways that disrupt hegemonic narratives. Dialectics of care and narrative agency are explored in the context of military-to-civilian ‘transition’ in Britain. We argue that the landscape of transition for military veterans is dominated by a preoccupation with employment and economic productivity, resulting in a ‘care deficit’ for veterans leaving the military. Through the Stories in Transition project, which used co-created film to explore narrative agency in the context of three veterans’ charities, we argue that the act of making care visible constitutes a necessary intervention in this transitional landscape. Grounding this intervention within feminist care ethics and the related notion of care aesthetics, we highlight the potential for film to reveal in compelling audio-visual narratives an alternative project of transition which might better sustain life and hope in the aftermath of military service.
The treatment recommendation based on a network meta-analysis (NMA) is usually the single treatment with the highest expected value (EV) on an evaluative function. We explore approaches that recommend multiple treatments and that penalise uncertainty, making them suitable for risk-averse decision-makers. We introduce loss-adjusted EV (LaEV) and compare it to GRADE and three probability-based rankings. We define properties of a valid ranking under uncertainty and other desirable properties of ranking systems. A two-stage process is proposed: the first identifies treatments superior to the reference treatment; the second identifies those that are also within a minimal clinically important difference (MCID) of the best treatment. Decision rules and ranking systems are compared on stylised examples and 10 NMAs used in NICE (National Institute of Health and Care Excellence) guidelines. Only LaEV reliably delivers valid rankings under uncertainty and has all the desirable properties. In 10 NMAs comparing between 5 and 41 treatments, an EV decision maker would recommend 4–14 treatments, and LaEV 0–3 (median 2) fewer. GRADE rules give rise to anomalies, and, like the probability-based rankings, the number of treatments recommended depends on arbitrary probability cutoffs. Among treatments that are superior to the reference, GRADE privileges the more uncertain ones, and in 3/10 cases, GRADE failed to recommend the treatment with the highest EV and LaEV. A two-stage approach based on MCID ensures that EV- and LaEV-based rules recommend a clinically appropriate number of treatments. For a risk-averse decision maker, LaEV is conservative, simple to implement, and has an independent theoretical foundation.
The Lyman alpha (Ly$\alpha$) forest in the spectra of $z\gt5$ quasars provides a powerful probe of the late stages of the epoch of reionisation (EoR). With the recent advent of exquisite datasets such as XQR-30, many models have struggled to reproduce the observed large-scale fluctuations in the Ly$\alpha$ opacity. Here we introduce a Bayesian analysis framework that forward-models large-scale lightcones of intergalactic medium (IGM) properties and accounts for unresolved sub-structure in the Ly$\alpha$ opacity by calibrating to higher-resolution hydrodynamic simulations. Our models directly connect physically intuitive galaxy properties with the corresponding IGM evolution, without having to tune ‘effective’ parameters or calibrate out the mean transmission. The forest data, in combination with UV luminosity functions and the CMB optical depth, are able to constrain global IGM properties at percent level precision in our fiducial model. Unlike many other works, we recover the forest observations without invoking a rapid drop in the ionising emissivity from $z\sim7$ to 5.5, which we attribute to our sub-grid model for recombinations. In this fiducial model, reionisation ends at $z=5.44\pm0.02$ and the EoR mid-point is at $z=7.7\pm0.1$. The ionising escape fraction increases towards faint galaxies, showing a mild redshift evolution at fixed UV magnitude, $M_\textrm{UV}$. Half of the ionising photons are provided by galaxies fainter than $M_\textrm{UV} \sim -12$, well below direct detection limits of optical/NIR instruments including $\textit{ JWST}$. We also show results from an alternative galaxy model that does not allow for a redshift evolution in the ionising escape fraction. Despite being decisively disfavoured by the Bayesian evidence, the posterior of this model is in qualitative agreement with that from our fiducial model. We caution, however, that our conclusions regarding the early stages of the EoR and which sources reionised the Universe are more model-dependent.
Objectives/Goals: To investigate interventional clinical trial participation overall and by race, gender, and age. Methods/Study Population: We used Epic Cosmos, an aggregated, de-identified EHR platform including over 270 million patients, to examine overall clinical trial participation and the race, gender, and age composition of participants versus non-participants. Patients ≥5 years old with known race and gender and at least one healthcare encounter between 2021 and 2024 were included. Interventional trial enrollment was identified by a “research flag” indicating current or past participation in an interventional study within an Epic system contributing data to Cosmos. Race was categorized as American Indian, Asian, Black, Native Hawaiian, or White. Age-adjusted relative representation (RR) ratios were used to compare participation, with RR >1 indicating over-representation and RR Results/Anticipated Results: Of 130,455,189 patients meeting eligibility criteria, 0.52% (673,425) of patients were active or inactive in an interventional clinical trial. Results are shown in the figure below. The poorest representation was from Asian and NH/PI persons. Representation was most similar to the patient population for whites and AI/AN persons. Black males participated less and women, more than predicted by patient composition. Older patients participated more frequently than younger (age, mean (SD), y, 53 (22) vs. 46 (23); p Discussion/Significance of Impact: This is the first study we know of describing interventional trial participation in the USA across millions and millions of patients. Further research is needed to clarify whether these differences are due to the nature of the studies themselves (e.g., OB/GYN trials including only women, etc.) versus disparities in recruitment or otherwise.
Objectives/Goals: Opioid use disorder (OUD) at delivery increased between 1999 and 2014. Clinical guidelines include medication for OUD (MOUD) for pregnant women with OUD and is associated with better fetal outcomes. Few large studies have compared prenatal MOUD outcomes to no MOUD. We evaluated the association of documented MOUD prescription during pregnancy with maternal outcomes. Methods/Study Population: We utilized aggregated electronic health records using the TriNetX platform to conduct a retrospective cohort study of females, aged 1249 years with a childbirth CPT code and documented opioid use via ICD-10 codes in the nine months before delivery between 2014 and 2020, comparing patients with MOUD prescription of buprenorphine or methadone during the nine months before delivery to demographically matched patients without any documented MOUD, using hazard ratios and 95% CIs for outcomes occurring one week to one or three years after childbirth. Results/Anticipated Results: MOUD cohort (n = 6,945, 85.33% White; 82.77% Non-Hispanic or Latino) was associated with significantly higher subsequent documented MOUD prescription (HR, 9.26 [95% CI, 7.98–10.76]; 6.21 [95% CI, 5.60–6.88]) and new remission codes (HR, 2.79 [95% CI, 2.15–3.62]; 2.85 [95% CI, 2.38–3.40]) at one and three years, lower ED visits at one year (HR, 0.88 [95% CI, 0.81–0.96]), no significant association of ED visits at three years (0.95 [95% CI, 0.89–1.02]), higher outpatient visits (HR, 1.26 [95% CI, 1.20–1.32]; HR, 1.27 [95% CI, 1.21–1.33], and no significant association of inpatient visits at one and three years (HR, 0.93 [95% CI, 0.813–1.06]; 1.06 [95% CI, 0.96–1.18]) than the never-MOUD cohort (n = 4,708, 76.11% White; 75.68% non-Hispanic or Latino). Discussion/Significance of Impact: A documented prescription for MOUD during pregnancy is associated with newly documented remission of OUD, increased outpatient visits, decreased ED visits, and additional documented MOUD prescriptions suggestive of increased access to continuity care. Efforts to increase MOUD use in pregnancy may improve maternal outcomes.
The January 6th insurrection and its aftermath of obfuscation and denial were ostensibly racialized events. Under the guise of election fraud, white supremacists, white nationalists, and paramilitary groups attempted to overthrow established democratic procedures to retain a president who stoked racial antagonisms and racial divisions. African Americans, like many American citizens, watched in fear, anxiety, and foreboding as the groups most committed to their repression violently attacked and ransacked the Capitol.
We examine the extent to which the January 6th insurrection and its aftermath of denial and obfuscation influence African Americans’ racial resentment. Our results show how the racialized January 6th events were connected to heightened African American racial resentment. The most compelling result confirms that African Americans’ racial resentment stems from beliefs about justice and fairness.
“Improper linear models” (see Dawes, Am. Psychol. 34:571–582, 1979), such as equal weighting, have garnered interest as alternatives to standard regression models. We analyze the general circumstances under which these models perform well by recasting a class of “improper” linear models as “proper” statistical models with a single predictor. We derive the upper bound on the mean squared error of this estimator and demonstrate that it has less variance than ordinary least squares estimates. We examine common choices of the weighting vector used in the literature, e.g., single variable heuristics and equal weighting, and illustrate their performance in various test cases.
On the standard “Wollheimian” reading of Collingwood’s aesthetics, Collingwood held that something is art in the true sense of the word when it involves an act of “expression” – understood in a particular way – on the part of the artist, and that artworks in all art-forms are “ideal” entities that, while externalizable, exist first and foremost in the mind of the expressive artist. I begin by providing a fuller account of the Wollheimian reading. I then survey challenges to and defenses of this reading, identifying residual difficulties confronting anyone who seeks to defend Collingwood. I attempt to resolve these difficulties by developing the idea that we take at face value Collingwood’s (overlooked) claim that the work of art is identical to the expressive activity of the artist rather than being identical to the expressive product of that activity, reading this claim in light of Collingwood’s talk about the painter as one who “paints imaginatively.”
The presence of an intraluminal thrombus in acutely symptomatic carotid stenosis is thought to represent a high-risk lesion for short-term stroke reccurrence though evidence on natural history and treatment is lacking, leading to equipoise and much variation in practice. The objective of this study was to map these variations in practice (medical management and timing of revascularization), determine the considerations that influence clinician decision-making in this condition and gather opinions that inform the development and design of future trials in the area.
Methods:
This was a mixed-methods study using both quantitative survey methods and qualitative interview-based methods. International perspectives were gathered by distributing a case-based survey via the “Practice Current” section of Neurology: Clinical Practice and interviewing international experts using established qualitative research methods.
Results:
The presence of an intraluminal thrombus significantly increased the likelihood of using a regimen containing anticoagulation agents (p < 0.001) in acutely symptomatic carotid stenosis in the case-based survey. Themes that emerged from qualitative interview analysis were therapeutic uncertainty regarding anticoagulation, decision to reimage, revascularization choices and future trial design and anticipated challenges.
Conclusion:
Results of this study demonstrate a preference for anticoagulation and delayed revascularization after reimaging to examine for clot resolution, though much equipoise remains. While there is interest from international experts in future trials, further study is needed to understand the natural history of this condition in order to inform trial design.
To tackle Britain's housing crisis, we need a commitment to build more than 300,000 new homes a year (the government's current commitment) and at least 150,000 of new homes should be social homes for rent.
The principles underlying Labour's housing policy should be that ‘levelling up’ means nothing less than demolishing inequality. Residential property and housing development are major economic sectors. Relatively cheap borrowing and house price inflation have been significant drivers of inequality, not only in higher end owner occupation, but also in the private rented sector, where incentives to private landlords have allowed them to outrun the capacity of ordinary renters to buy in. The private rented sector has also been fuelled by the ‘right’ to buy council homes with a high proportion no longer in owner occupation long term.
Planning and levelling up
We believe that for too long Labour has failed to recognise that the planning system, and in particular planning policy, provide wellestablished tools to enable us to fulfil our policy objectives. So long as the National Planning Policy Framework and local development plans contain the right locational social objectives, planning authorities will be able to decide whether a proposal (whether for housing or another form of development) is in conformity with those objectives and make planning decisions accordingly. They will also be able to use planning agreements, not merely to facilitate but also positively to promote socially acceptable development, such as affordable housing. The use of these powers will be critical in enabling authorities to insist on key regional development sites being invested in rather than those where the biggest profits can be made. Labour should review and implement changes to financial viability assessments and appraisals that are currently used to drastically reduce the number of affordable houses being delivered in developments across the country. It has already been noted that changes on viability could increase the numbers of affordable homes.
Labour had rightly pledged to end the inclusion of ‘hope value’ in the valuation of land being purchased by local authorities under a Compulsory Purchase Order (CPO). This will enable more land to be purchased for socially acceptable development.
Ambitious reform, and resources, are necessary so that all three housing sectors – homeownership, the social rented sector and the private rented sector (PRS) – become accessible, affordable and safe. These sectors cannot be considered in isolation from one another. The proposals to enhance the rights of renters and homeless applicants considered in this chapter will be of limited practical benefit without measures to significantly increase the availability of all forms of housing, considered in Chapter 6.
The core value of any Labour programme for housing and law reform should be a commitment to housing as a human right. This would mean that Labour will respect and implement Article 11 of the International Covenant on Economic, Cultural and Social Rights: ‘[T] he right of everyone to an adequate standard of living for himself and his family, including adequate food, clothing and housing, and to the continuous improvement of living conditions.’
The rights we propose are meaningless if they cannot be enforced. The legal aid sector is in a crisis of sustainability and Law Society research shows that 26 million people do not have access to a local legal aid housing lawyer. This chapter concludes with proposals to significantly increase the availability of advice and representation for people experiencing housing issues.
Private rented sector
After 40 years of little or no regulation of the PRS, the government published, on 17 May 2023, the Renters’ (Reform) Bill, implementing its pledge to abolish s.21 ‘no fault’ evictions four years after having committed to do so. At the time of writing, the Bill had (on 15 May 2024) passed its Second Reading in the House of Lords. It is now doubtful when it will come into force owing to amendments from Conservative MPs, which have been accepted by the government, and which postpone implementation until the Lord Chancellor has assessed the operation of the process for obtaining possession orders in the County Court. Abolition of s.21, along with the establishment of a PRS Ombudsman and a database for residential landlords are welcome and we support them. However, a number of the new mandatory grounds for possession are open to abuse.