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.

Background: Black, Asian and Minority Ethnic (BAME) people continue to present later to specialist care centres and services for memory problems. This poses significant concerns due to implications for poorer treatment outcomes and higher treatment cost among this population. While diverse interventions to support improved help seeking for dementia have been proffered for other BAME communities, there is a paucity of research involving the Black African and Caribbean community. Furthermore, whilst community health professionals like the doctors and community nurses have been involved in such interventions, no previous research has considered the role of the community pharmacist. This research explored opportunities for community pharmacists to support improved help seeking for dementia among the Black African and Caribbean population.

Methods: This research was a multi-stage project involving surveys and interviews with community pharmacists and Black Africans and Caribbeans as participants.

Results: Knowledge, attitude and beliefs around dementia and it’s causes appeared to be major barriers to help seeking among the Black African and Caribbean population. For example, beliefs that dementia is caused by ‘the spirits’ and dementia is a repercussion for past wrongdoing and therefore not amenable to medical intervention. The community pharmacists believe they are well positioned to spot initial signs of dementia among their clients and are therefore willing to offer help seeking support to this population.

Conclusions: To offer intervention for timely help-seeking for dementia, a culturally tailored dementia education for the Black African and Caribbean population should be considered. In addition, training on the impact of cultural beliefs on help seeking for dementia should be considered for the communitypharmacists.

Background: The number of advanced practice providers (APPs)—nurse practitioners (NPs) and physician assistants (PAs)—continues to expand across the United States. Several studies suggest differences in antibiotic prescribing rates and appropriateness by APPs compared to physicians. The objective of this analysis is to characterize population- and provider-specific outpatient antibiotic prescribing rates among physicians and APPs nationally, by state, and within urban versus rural counties. Methods: We estimated outpatient oral antibiotic prescription rates for 2011 and 2022 using county-level prescription dispensing data from IQVIA Xponent® (numerator) and population census estimates (denominator). Provider specialty denominators were provided by IQVIA, based on data from the American Medical Association. Counties were classified as urban or rural per the 2013 National Center for Health Statistics classification. National and state-level prescription volume, rates per 1000 population, and average number of prescriptions per provider were calculated for physicians, NPs, and PAs. We assessed the degree to which provider-specific rates explained the variance of the overall rate by state, using the coefficient of determination (r2) from Pearson’s correlation. Results: Between 2011 and 2022, overall U.S. antibiotic prescribing declined from 877 to 709 per 1000 population, a 19.2% relative reduction. The provider-specific proportion of the overall prescribing rate relatively decreased by 32% for physicians but increased by 157% for APPs (NPs 229%, PAs 86%; Figure 1). State-level antibiotic prescribing rates varied by provider type for both years, shifting towards proportionally greater APP prescribing in 2022 (Figure 2). For 2011 and 2022, physician prescribing rate strongly correlated with the overall state rate (r2 = 0.83 in 2011 versus 0.80 in 2022), whereas the correlation of the NP prescribing rate increased (r2 = 0.20 in 2011 versus 0.76 in 2022). A total of 60,327 (7.2%) physicians practiced in rural settings in contrast to 42,876 (12%) NPs and 14,495 (9.4%) PAs in 2022. Providers in rural counties prescribed more antibiotics per provider on average compared to urban counties; rural physicians prescribed 57% more antibiotics per provider (207 vs 132 antibiotics per provider), rural NPs prescribed 115% more (284 vs 132), and rural PAs prescribed 53% more (289 vs 189). Conclusions: The relative contribution of APPs to outpatient antibiotic prescriptions more than doubled over the past decade, accounting for 1 in 3 prescriptions in 2022. This contribution was especially prominent among NPs in rural counties. Further evaluation of antibiotic prescribing appropriateness among APPs and integration of APPs into antibiotic stewardship efforts in various settings.

Like the polar bear beleaguered by global warming, artificial intelligence (AI) serves as the charismatic megafauna of an entangled set of local and global histories of science, technology and economics. This Themes issue develops a new perspective on AI that moves beyond conventional origin myths – AI was invented at Dartmouth in the summer of 1956, or by Alan Turing in 1950 – and reframes contemporary critique by establishing plural genealogies that situate AI within deeper histories and broader geographies. ChatGPT and art produced by AI are described as generative but are better understood as forms of pastiche based upon the use of existing infrastructures, often in ways that reflect stereotypes. The power of these tools is predicated on the fact that the Internet was first imagined and framed as a ‘commons’ when actually it has created a stockpile for centralized control over (or the extraction and exploitation of) recursive, iterative and creative work. As with most computer technologies, the ‘freedom’ and ‘flexibility’ that these tools promise also depends on a loss of agency, control and freedom for many, in this case the artists, writers and researchers who have made their work accessible in this way. Thus, rather than fixate on the latest promissory technology or focus on a relatively small set of elite academic pursuits born out of a marriage between logic, statistics and modern digital computing, we explore AI as a diffuse set of technologies and systems of epistemic and political power that participate in broader historical trajectories than are traditionally offered, expanding the scope of what ‘history of AI’ is a history of.

Arid regions are especially vulnerable to climate change and land use. More than one-third of Earth's population relies on these ecosystems. Modern observations lack the temporal depth to determine vegetation responses to climate and human activity, but paleoecological and archaeological records can be used to investigate these relationships. Decreasing rainfall across the Late Holocene provides a case study for vegetation response to changing hydroclimate. Rock hyrax (Procavia capensis) middens preserve paleoenvironmental indicators in arid environments where traditional archives are unavailable. Pollen from modern middens collected in Dhofar, Oman, demonstrates the reliability of this archive. Pollen, stable isotope (δ13C, δ15N), and microcharcoal data from fossil middens reveal changes in vegetation, relative moisture, and fire from 4000 cal yr BP to the present. Trees limited to moister areas (e.g., Terminalia) today existed farther inland at ~3100 cal yr BP. After ~2900 cal yr BP, taxa with more xeric affiliations (e.g., Senegalia) had increased. Coprophilous fungal spores (Sporormiella) and grazing indicator pollen revealed an amplified signal of domesticate grazing at ~1000 cal yr BP. This indicates that trees associated with semiarid environments were maintained in the interior desert during ~3000–4000 yr of decreasing rainfall and that impacts of human activity intensified after the transition to a drier environment.

How can we close persistent gender gaps in political participation? We develop a theory highlighting the role of male household members as “gatekeepers” of women’s participation in patriarchal settings and argue that the answer involves targeting these men. We conduct a field experiment in Pakistan and find that targeting women with a nonpartisan get-out-the-vote campaign has no effect on their turnout in a national election. However, women’s turnout increases substantially when male household members are canvassed to support women’s participation. Households where both men and women are canvassed see the largest increases in women’s turnout and additional increases in political discussion and men’s practical support to help women vote. Using a costly behavioral measure, we also demonstrate lasting effects on men’s supportive behavior in these households two months after the election. Our results address the importance, and tangible benefits, of engaging men to ease constraints that hinder equal participation.

Consumers are increasingly interested in the sustainability of food products, but so far, no specific European Union (EU) legislation has been developed to harmonise sustainability claims. We analyse which efforts already undertaken within the EU dealing with sustainability claims on products apply to sustainable food claims. We show that whilst sustainability can address three different dimensions (environmental, social and economic), it is crucial to clearly define sustainability in order to allow for the development of concrete regulations and guidance documents. EU legislative initiatives so far seem to be focused on environmental aspects, whilst Member States approach sustainability more broadly. At the same time, substantiation methods can only be successful when sustainability is well defined. We conclude that whilst there is a large range of initiatives taken at different levels, the foundation of these initiatives remains weak when there is no clear scope of terminology nor clarification of substantiation requirements. Currently existing self-regulatory initiatives could support protecting consumers from misleading claims by providing specific provisions for (food) business operators on how to make sustainability claims. Only when claims can be trusted and understood by consumers will they be able to make more sustainable purchase decisions. This plays an important role in the overall policy objective of the EU of climate neutrality by 2050.

The prenatal period represents a critical time for brain growth and development. These rapid neurological advances render the fetus susceptible to various influences with life-long implications for mental health. Maternal distress signals are a dominant early life influence, contributing to birth outcomes and risk for offspring psychopathology. This prospective longitudinal study evaluated the association between prenatal maternal distress and infant white matter microstructure. Participants included a racially and socioeconomically diverse sample of 85 mother–infant dyads. Prenatal distress was assessed at 17 and 29 weeks’ gestational age (GA). Infant structural data were collected via diffusion tensor imaging (DTI) at 42–45 weeks’ postconceptional age. Findings demonstrated that higher prenatal maternal distress at 29 weeks’ GA was associated with increased fractional anisotropy, b = .283, t(64) = 2.319, p = .024, and with increased axial diffusivity, b = .254, t(64) = 2.067, p = .043, within the right anterior cingulate white matter tract. No other significant associations were found with prenatal distress exposure and tract fractional anisotropy or axial diffusivity at 29 weeks’ GA, or earlier in gestation.