Modern market economies use competitions to distribute a range of social goods. Some theorists maintain that such competitions ought not to generate winner-takes-all outcomes. But the arguments that have been given against competitions with winner-takes-all outcomes fail to find fault with winner-takes-all outcomes per se (or so I argue). Is there, then, anything wrong with winner-takes-all outcomes? I argue that there is: winner-takes-all outcomes are wrong, in at least most distributive competitions, because they do not give people what they deserve.

Background: The complement component C5 inhibitor, ravulizumab, is approved in Canada for the treatment of adults with AQP4-Ab+ NMOSD. Updated efficacy and safety results from the ongoing CHAMPION-NMOSD (NCT04201262) trial are reported. Methods: Participants received IV-administered, weight-based dosing of ravulizumab, with loading on day 1 and maintenance doses on day 15 and every 8 weeks thereafter. Following a primary treatment period (PTP; up to 2.5 years), patients could enter a long-term extension (LTE). Outcome measures included safety, time to first adjudicated on-trial relapse (OTR), risk reduction, and disability scores. Results: 56/41 patients entered/completed the LTE as of June 14, 2024. Median follow-up was 170.3 weeks (186.6 patient-years). No patients experienced an OTR. 94.8% (55/58 patients) had stable or improved Hauser Ambulation Index scores. 89.7% (52/58 patients) had no clinically important worsening in Expanded Disability Status Scale scores. Treatment-emergent adverse events (98.4%) were predominantly mild and unrelated to ravulizumab. Serious adverse events occurred in 25.9% of patients. Two cases of meningococcal infection occurred during the PTP, and none in the LTE. One unrelated death (cardiovascular) occurred during the LTE. Conclusions: Ravulizumab demonstrated long-term clinical benefit in AQP4-Ab+ NMOSD relapse prevention while maintaining or improving disability measures, with no new safety concerns.

Background: Attitudes toward aging influence many health outcomes, yet their relationship with cognition and Alzheimer’s disease (AD) remains unknown. To better understand their impact on cognition and AD risk, we examined whether positive attitudes predict better cognition and diminished risk on AD biomarkers. Methods: A subsample of older adults with a family history of AD (n=54; women=39) from the McGill PREVENT-AD cohort participated in this study. Participants completed the Attitudes to Ageing Questionnaire (AAQ-24), providing three scores: psychosocial loss, psychological growth and physical change. Participants underwent cognitive testing (Rey Auditory Verbal Learning Test, RAVLT; Delis-Kaplan Executive Function System-Color Word Interference Test, D-KEFS-CWIT), and AD blood-based biomarker assessments (p-tau217, Aβ42/40). Regression models tested associations, adjusting for covariates (age, sex, education, depression, APOE4), and were Bonferroni corrected. Results: Positive attitudes were associated with better recall and recognition (RAVLT) and improved word reading, colour naming, switching, and inhibition (D-KEFS-CWIT) (p<0.00077), while negative attitudes showed the opposite pattern. Negative attitudes were correlated with lower Aβ42/40 ratios, while positive attitudes were linked to lower p-tau217 (p<0.0167). Conclusions: These findings demonstrate that positive attitudes predict better cognition and a lower risk profile for AD biomarkers, suggesting that life outlook may be an early disease feature or a risk factor.

This retrospective review describes changes in prophylactic antibiotic prescribing practices for Veterans undergoing transrectal ultrasound-guided prostate biopsy (TRUPB) and the incidence of post TRUPB infection-related hospitalizations before and after an antimicrobial stewardship intervention.

Recent evidence from cross-situational learning (CSL) studies have shown that adult learners can acquire words and grammar simultaneously when sentences of the novel language co-occur with dynamic scenes to which they refer. Syntactic bootstrapping accounts suggest that grammatical knowledge may help scaffold vocabulary acquisition by constraining possible meanings, thus, for children, words and grammar may be acquired at different rates. Twenty children (ages 8 to 9) were exposed in a CSSL study to an artificial language comprising nouns, verbs, and case markers occurring within a verb-final grammatical structure. Children acquired syntax (i.e., word order) effectively, but we found no evidence of vocabulary learning, whereas previous adult studies showed learning of both from similar input. Grammatical information may thus be available early for children, to help constrain and support later vocabulary learning. We propose that gradual maturation of declarative memory systems may result in more effective vocabulary learning in adults.

Now mostly derided as a musical vandal, the cellist Friedrich Grützmacher (1832–1903) was seen during his lifetime as a noble and serious artist, highly respected as a performer and sought-after as a teacher. His numerous and heavily annotated performing editions – and in particular his pedagogical editions of older works – represent his attempt to preserve and disseminate a style of playing that was referred to at the time as ‘classical’ (classisch or klassisch). While the concept of classic works, as it developed in the nineteenth century, has been studied in depth by Lydia Goehr, William Weber and others, the related yet distinct concept of classical musicianship is relatively unexplored. This chapter traces the cultural resonances of the term ‘classisch’ as it was used in the German-speaking press over the course of Grützmacher’s lifetime, arguing that it represents a complement or parallel to the idea of classic works, with an independent connection to Romantic Idealism and Hellenism. The chapter then examines the performance practice implications of classical musicianship through the lens of Grützmacher’s editions, with a particular focus on a disciplined sense of tempo, a grand and tranquil physical presence, and a highly nuanced use of the bow in the service of musical character. Viewing classical musicianship in this way clears Grützmacher’s editions of the charge of vandalism by challenging us to reconsider the ideal relationship between composer and performer, as well as the fundamental purpose of an edition.

Aims: The unique demands of studying for a healthcare-related degree are associated with an increased risk of developing mental health problems. Stigma and fear of repercussions for their future careers may be a barrier to these students seeking professional help. Mental Health First Aid (MHFA) is a globally disseminated psycho-education course, training members of the public to recognise and respond to people experiencing mental health problems in their communities. Training healthcare professional (HCP) students in MHFA may help them support their peers and optimise their own wellbeing.

We aimed to review the literature regarding experiences of MHFA in medical, nursing and allied HCP students and its impact on mental health knowledge, confidence and skills in supporting others, stigmatising attitudes, self-care, peer support and student wellbeing.

Methods: This systematic review was conducted in accordance with PRISMA guidelines and registered on PROSPERO (ID: CRD42024589509). Electronic databases (Ovid, Medline, PsycINFO, CINAHL and ERIC) were searched on 9/10/2024 for primary studies evaluating the impact of MHFA in HCP students. Data was extracted independently by two authors. Study quality was assessed using the MMERSQI (Modified Medical Education Research Study Quality Instrument) and Cochrane Risk of Bias tool.

Results: Searches identified 1613 studies, 25 of which met inclusion criteria. Study types were heterogeneous, including four randomised controlled trials (RCTs) and four qualitative studies. Eight studies reported that MHFA significantly improved post-test knowledge and mental health literacy. Fourteen studies reported enhanced confidence in providing MHFA post-training. Three studies described outcomes based on performance on simulation assessments, and eight studies reported reduction in discriminatory attitudes following MHFA training. Data on peer support and student wellbeing was limited. Qualitative studies suggested that MHFA clarified misconceptions around mental illness, facilitated supporting friends and family, and helped with self-care and seeking professional support for their own mental health. Student pharmacists felt that skills gained from MHFA were particularly advantageous in their professional roles. Qualitative data also suggested that tailored content for HCP students and increased pace of delivery would be beneficial.

Conclusion: The evidence base on this topic is limited, with many small studies and few RCTs. However, the available literature suggests that MHFA may be a promising strategy to improve mental health literacy, confidence, skills, and reduce stigma in HCP students. Findings suggest that there is demand for bespoke MHFA courses for HCP students, which may fulfil an unmet need in facilitating them to provide support to their peers, and optimise their own wellbeing.

Aims: The Kent and Medway Psychiatry Undergraduate Scheme (KAMPUS) aims to provide medical students with experience in psychiatry at an early stage in their training, and psychiatry trainees the opportunity to develop mentoring and leadership skills.

Early exposure to psychiatry improves student perceptions of the specialty. KAMPUS is based on a similar programme in a London medical school which has reported positive outcomes. KAMPUS was adapted for the structure and geography of the local medical school and mental health trust.

Methods: A committee of psychiatrists, trainees and student representatives co-developed KAMPUS and wrote handbooks for students, trainees and clinical supervisors. Year 1–2 students and core psychiatry trainees were invited to participate. 18 students and 15 trainees registered for KAMPUS in the 2023–2024 academic year. Lead mentors supported small groups of students virtually, and clinic-based mentors were trainees based near the school, who provided clinical shadowing opportunities. Combined educational/social events were organised in collaboration with the Psychiatry Society, and a formal day of mentoring training was provided for trainees.

Results: Trainees provided regular mentoring and shadowing opportunities. Lead mentor group discussion topics included training pathways, case presentations and practice exam questions. Two educational/social events were attended by students and trainees. Trainees gave positive feedback regarding mentoring training.

Conclusion: KAMPUS is deliverable across the wide geographical area covered by the medical school and mental health trust in Kent. It has provided early experience in psychiatry for students and a development opportunity for trainees, with positive initial feedback.

Aims: Attention Deficit Hyperactivity Disorder (ADHD) is more prevalent in adults with an intellectual disability (ID). NHS Digital reported the prevalence of ADHD in the ID population to be 9% in 2023–2024, compared with 1.2% in those without ID. Understanding the prevalence of ADHD within our Mental Health of Learning Disabilities (MHLD) team is crucial for tailoring our services accordingly and improving patient care. We decided to complete an audit across Kent and Medway to assess the degree of service demand arising from the diagnosis and treatment of ADHD in patients already open to the MHLD service, and to assess our adherence to NICE guidance for medication monitoring for ADHD medications.

Methods: A cross-sectional study of all patients currently open to MHLD was conducted. Total numbers across MHLD were recorded, as well as the split between the East and West Kent caseloads. All case notes, clinic letters and GP records were reviewed to identify whether a diagnosis of ADHD (or possible ADHD) was present. Once identified, a deep dive of patient records took place to check medication history and GP monitoring. Information was collated about the type of medication prescribed and length of prescription and whether monitoring had been carried out over the past 6 months in accordance with NICE guidance.

Results: We found that 15% (N=97) of all MHLD patients (N=629) had a confirmed diagnosis of ADHD, with 65.5% male and 34.5% female. The mean age of these patients was 24.6. Of those with confirmed diagnoses of ADHD, 43% (N=42) were prescribed medication. The most commonly prescribed medication was methylphenidate (62%), followed by atomoxetine (14%) and lisdexamfetamine (9.5%). Most patients had been on ADHD medication for less than 1 year (31%), with only 7% of patients being prescribed ADHD medication for over 10 years. With regards to medication monitoring, for those prescribed ADHD medication, 83% had their weight measured in the last 6 months, 76.5% had their pulse measured and 64% had their blood pressure measured.

Conclusion: This audit suggests that the rate of ID and ADHD in our clinical sample is higher than the estimated population prevalence. This will have implications for service development and training requirements, meaning that clear pathways will need to be established, with available resources and adequate monitoring in place to ensure the needs of our patient group are being met, and current NICE guidance is adhered to.

This systematic review aims to evaluate the effectiveness of various physical environmental enrichment items such as brushes, ropes, teats, chains, balls, cowhides/blocks, at improving the welfare of indoor-housed calves, heifers, and cattle. This review of 33 peer-reviewed papers and one industry report evaluated different welfare-related outcomes following physical environmental enrichment, including feed intake, lying time, play and exploratory behaviour, aggression, stereotypic behaviour and cross-sucking behaviour. The results of the meta-analysis revealed that calves and heifers enrolled in experimental studies using enrichment items had significantly improved growth rates, and increased locomotor play, but the overall reduction in cross-sucking behaviour was small and non-significant. The effect of enrichment on feed intake, aggression/stereotypic behaviour, play behaviour, cleanliness score contrasted between studies, with some reporting improvements while others showed no effect of environmental enrichment in these parameters. The risk of bias assessment revealed limitations in researcher blinding, sequence generation, and allocation concealment across the literature assessing the effectiveness of environmental enrichment on animal welfare. Overall, this review underscores the significant positive impact of physical enrichment on the welfare and behaviour of indoor-housed cattle, while highlighting the need for further research to optimise enrichment strategies across different cattle age groups and housing conditions.