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Accessibility at the Sterkfontein Caves UNESCO World Heritage Site limits public and scientific engagement. The authors digitally visualised part of the cave using laser scans and photogrammetry, geospatially integrating the digital cave and fossil datasets. This enables broader access for learners, educators and scientists and enhances scientific outreach potential.
Abrupt cessation of heavy cannabis use can cause a withdrawal syndrome characterised by irritability, anxiety, insomnia, reduced appetite and restlessness. Recent reports have also described people in whom cannabis withdrawal immediately preceded the acute onset of psychosis.
Aims
To identify cases of psychosis associated with cannabis withdrawal.
Method
We completed a systematic review of the literature, which comprised case reports, case series and other studies. We also searched a large electronic database of psychiatric healthcare records.
Results
The systematic review identified 44 individuals from 21 studies in whom cannabis withdrawal preceded the development of acute psychosis. In the health record study, we identified another 68 people, of whom 47 involved a first episode of psychosis and 21 represented further episodes of an existing psychotic disorder. Almost all people were daily cannabis users who had stopped using cannabis abruptly. Individuals who continued to use cannabis after the acute psychotic episode had a much higher risk of subsequent relapse than those who abstained (odds ratio 13.9 [95% CI: 4.1 to 56.9]; χ2 = 20.1, P < 0.00001).
Conclusions
Abrupt cannabis withdrawal may act as a trigger for the first episode of psychosis and a relapse of an existing psychosis. Acute psychotic symptoms can emerge after the cessation, as well as following the use, of cannabis.
Transition to psychosis rates within ultra-high risk (UHR) services have been declining. It may be possible to ‘enrich’ UHR cohorts based on the environmental characteristics seen more commonly in first-episode psychosis cohorts. This study aimed to determine whether transition rates varied according to the accumulated exposure to environmental risk factors at the individual (migrant status, asylum seeker/refugee status, indigenous population, cannabis/methamphetamine use), family (family history or parental separation), and neighborhood (population density, social deprivation, and fragmentation) level.
Methods
The study included UHR people aged 15–24 who attended the PACE clinic from 2012 to 2016. Cox proportional hazards models (frequentist and Bayesian) were used to assess the association between individual and accumulated factors and transition to psychosis. UHR status and transition was determined using the CAARMS. Benjamini–Hochberg was used to correct for multiple comparisons in frequentist analyses.
Results
Of the 461 young people included, 55.5% were female and median follow-up was 307 days (IQR: 188–557) and 17.6% (n = 81) transitioned to a psychotic disorder. The proportion who transitioned increased incrementally according to the number of individual-level risk factors present (HR = 1.51, 95% CIs 1.19–1.93, p < 0.001, pcorr = 0.01). The number of family- and neighborhood-level exposures did not increase transition risk (p > 0.05). Cannabis use was the only specific risk factor significantly associated with transition (HR = 1.89, 95% CIs 1.22–2.93, pcorr = 0.03, BF = 6.74).
Conclusions
There is a dose–response relationship between exposure to individual-level psychosis-related environmental risk factors and transition risk in UHR patients. If replicated, this could be incorporated into a novel approach to identifying the highest-risk individuals within clinical services.
The pressures exerted by the coronavirus disease 2019 (COVID-19) pandemic pose an unprecedented demand on healthcare services. Hospitals become rapidly overwhelmed when patients requiring life-saving support outpace available capacities.
Objective:
We describe methods used by a university hospital to forecast case loads and time to peak incidence.
Methods:
We developed a set of models to forecast incidence among the hospital catchment population and to describe the COVID-19 patient hospital-care pathway. The first forecast utilized data from antecedent allopatric epidemics and parameterized the care-pathway model according to expert opinion (ie, the static model). Once sufficient local data were available, trends for the time-dependent effective reproduction number were fitted, and the care pathway was reparameterized using hazards for real patient admission, referrals, and discharge (ie, the dynamic model).
Results:
The static model, deployed before the epidemic, exaggerated the bed occupancy for general wards (116 forecasted vs 66 observed), ICUs (47 forecasted vs 34 observed), and predicted the peak too late: general ward forecast April 9 and observed April 8 and ICU forecast April 19 and observed April 8. After April 5, the dynamic model could be run daily, and its precision improved with increasing availability of empirical local data.
Conclusions:
The models provided data-based guidance for the preparation and allocation of critical resources of a university hospital well in advance of the epidemic surge, despite overestimating the service demand. Overestimates should resolve when the population contact pattern before and during restrictions can be taken into account, but for now they may provide an acceptable safety margin for preparing during times of uncertainty.
Acute and transient psychotic disorders (ATPD) are characterized by an acute onset and a remitting course, and overlap with subgroups of the clinical high-risk state for psychosis. The long-term course and outcomes of ATPD are not completely clear.
Methods:
Electronic health record-based retrospective cohort study, including all patients who received a first index diagnosis of ATPD (F23, ICD-10) within the South London and Maudsley (SLaM) National Health Service Trust, between 1 st April 2006 and 15th June 2017. The primary outcome was risk of developing persistent psychotic disorders, defined as the development of any ICD-10 diagnoses of non-organic psychotic disorders. Cumulative risk of psychosis onset was estimated through Kaplan-Meier failure functions (non-competing risks) and Greenwood confidence intervals.
Results:
A total of 3074 patients receiving a first index diagnosis of ATPD (F23, ICD-10) within SLaM were included. The mean follow-up was 1495 days. After 8-year, 1883 cases (61.26%) retained the index diagnosis of ATPD; the remaining developed psychosis. The cumulative incidence (Kaplan-Meier failure function) of risk of developing any ICD-10 non-organic psychotic disorder was 16.10% at 1-year (95%CI 14.83–17.47%), 28.41% at 2-year (95%CI 26.80–30.09%), 33.96% at 3-year (95% CI 32.25–35.75%), 36.85% at 4-year (95%CI 35.07–38.69%), 40.99% at 5-year (95% CI 39.12–42.92%), 42.58% at 6-year (95%CI 40.67–44.55%), 44.65% at 7-year (95% CI 42.66–46.69%), and 46.25% at 8-year (95% CI 44.17–48.37%). The cumulative risk of schizophrenia-spectrum disorder at 8-year was 36.14% (95% CI 34.09–38.27%).
Conclusions:
Individuals with ATPD have a very high risk of developing persistent psychotic disorders and may benefit from early detection and preventive treatments to improve their outcomes.
We introduce two new bases of the ring of polynomials and study their relations to known bases. The first basis is the quasi-Lascoux basis, which is simultaneously both a $K$-theoretic deformation of the quasi-key basis and also a lift of the $K$-analogue of the quasi-Schur basis from quasi-symmetric polynomials to general polynomials. We give positive expansions of this quasi-Lascoux basis into the glide and Lascoux atom bases, as well as a positive expansion of the Lascoux basis into the quasi-Lascoux basis. As a special case, these expansions give the first proof that the $K$-analogues of quasi-Schur polynomials expand positively in multifundamental quasi-symmetric polynomials of T. Lam and P. Pylyavskyy.
The second new basis is the kaon basis, a $K$-theoretic deformation of the fundamental particle basis. We give positive expansions of the glide and Lascoux atom bases into this kaon basis.
Throughout, we explore how the relationships among these $K$-analogues mirror the relationships among their cohomological counterparts. We make several “alternating sum” conjectures that are suggestive of Euler characteristic calculations.
The first episode of psychosis is a critical period in the emergence of cardiometabolic risk.
Aims
We set out to explore the influence of individual and lifestyle factors on cardiometabolic outcomes in early psychosis.
Method
This was a prospective cohort study of 293 UK adults presenting with first-episode psychosis investigating the influence of sociodemographics, lifestyle (physical activity, sedentary behaviour, nutrition, smoking, alcohol, substance use) and medication on cardiometabolic outcomes over the following 12 months.
Results
Rates of obesity and glucose dysregulation rose from 17.8% and 12%, respectively, at baseline to 23.7% and 23.7% at 1 year. Little change was seen over time in the 76.8% tobacco smoking rate or the quarter who were sedentary for over 10 h daily. We found no association between lifestyle at baseline or type of antipsychotic medication prescribed with either baseline or 1-year cardiometabolic outcomes. Median haemoglobin A1c (HbA1c) rose by 3.3 mmol/mol in participants from Black and minority ethnic (BME) groups, with little change observed in their White counterparts. At 12 months, one-third of those with BME heritage exceeded the threshold for prediabetes (HbA1c >39 mmol/mol).
Conclusions
Unhealthy lifestyle choices are prevalent in early psychosis and cardiometabolic risk worsens over the next year, creating an important window for prevention. We found no evidence, however, that preventative strategies should be preferentially directed based on lifestyle habits. Further work is needed to determine whether clinical strategies should allow for differential patterns of emergence of cardiometabolic risk in people of different ethnicities.
Patients with acute and transient psychotic disorders (ATPDs) are by definition remitting, but have a high risk of developing persistent psychoses, resembling a subgroup of individuals at Clinical High Risk for Psychosis (CHR-P). Their pathways to care, treatment offered and long-term clinical outcomes beyond risk to psychosis are unexplored. We conducted an electronic health record-based retrospective cohort study including patients with ATPDs within the SLaM NHS Trust and followed-up to 8 years.
Methods:
A total of 2561 ATPDs were included in the study. A minority were detected (8%) and treated (18%) by Early Intervention services (EIS) and none by CHR-P services. Patients were offered a clinical follow-up of 350.40 ± 589.90 days. The cumulative incidence of discharges was 40% at 3 months, 60% at 1 year, 69% at 2 years, 77% at 4 years, and 82% at 8 years. Treatment was heterogeneous: the majority of patients received antipsychotics (up to 52%), only a tiny minority psychotherapy (up to 8%).
Results:
Over follow-up, 32.88% and 28.54% of ATPDS received at least one mental health hospitalization or one compulsory hospital admission under the Mental Health Act, respectively. The mean number of days spent in psychiatric hospital was 66.39 ± 239.44 days.
Conclusions:
The majority of ATPDs are not detected/treated by EIS or CHR-P services, receive heterogeneous treatments and short-term clinical follow-up. ATPDs have a high risk of developing severe clinical outcomes beyond persistent psychotic disorders and unmet clinical needs that are not targeted by current mental health services.
We consider the inertia-dominated rise of a meniscus around a vertical circular cylinder. Previous experiments and scaling analysis suggest that the height of the meniscus, $h_{m}$, grows with the time following the initiation of rise, $t$, like $h_{m}\propto t^{1/2}$. This is in contrast to the rise on a vertical plate, which obeys the classic capillary–inertia scaling $h_{m}\propto t^{2/3}$. We highlight a subtlety in the scaling analysis that yielded $h_{m}\propto t^{1/2}$ and investigate the consequences of this subtlety. We develop a potential flow model of the dynamic problem, which we solve using the finite element method. Our numerical results agree well with previous experiments but suggest that the correct early time behaviour is, in fact, $h_{m}\propto t^{2/3}$. Furthermore, we show that at intermediate times the dynamic rise of the meniscus is governed by two parameters: the contact angle and the cylinder radius measured relative to the capillary length scale, $t^{2/3}$. This result allows us to collapse previous experimental results with different cylinder radii (but similar static contact angles) onto a single master curve.
By
Dominic Scott, Professor of Philosophy University of Virginia Charlottesville,
Alex Oliver, University Reader in Philosophy University of Cambridge; Caius College,
Miguel Ley-Pineda, Faculty of Philosophy University of Cambridge
In this chapter, we investigate the idea of trade marks as property. Three questions need to be answered. The first is a conceptual matter: are trade marks capable of being property or are they ruled out as a matter of conceptual necessity? The second is conceptual-cum-descriptive: is the current law's treatment of trade marks treatment of them as property? The third is normative: if the current law does in fact treat them as property, is it right to do so? The questions need to be tackled in turn.
Are trade marks capable of being property?
When we ask whether trade marks are capable of being property, we are of course assuming that it makes sense to speak of things (resources, assets) being property. In other words, we assume with the layman and the practising lawyer that it makes sense to speak of an owner of a thing, where the thing owned is the property. Admittedly, among legal theorists there is a long tradition going back to Bentham that ridicules this way of speaking. It insists that property is best characterized not as the thing itself but as a bundle of normative relationships between people concerning the use of the thing. But, as Harris has rightly argued, this is a false opposition. In particular, scepticism about the very idea of ownership of a thing is generally based on the thesis that ownership involves the right to use a thing in any way one pleases.
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