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Do parties respond to inequality? Despite the relevance of inequality and its consequences, existing studies fail to capture parties’ emphasis on economic equality and redistribution or to differentiate between existing levels of inequality and increases in inequality. Based on 850,000 party statements from 12 (Organisation for Economic Co-operation and Development) countries (1970–2020), we introduce a crowd-coded dataset that allows us to distinguish positive references to economic equality and redistribution from upward-trending equal-rights/anti-discrimination rhetoric. We show that responses found in previous studies do not capture economic equality and redistribution. In reassessing the impact of inequality, we argue that low visibility, status quo bias, and turnout effects discourage party responses to high inequality levels, while rising inequality poses a visible status quo change and a threat that left parties respond to. We find that left parties respond to inequality increases (except less tangible gains among the most affluent) but not to (high) inequality levels. This helps to understand why inequality is not self-correcting.
Background: Recent research has demonstrated that DBS sites in Alzheimer’s (AD) and Parkinson’s (PD) influencing cognition are functionally connected to the subiculum. However, the results are mixed, and it is unclear how or if DBS site-subiculum connectivity can be optimized to improve patient cognition. Methods: We studied how subiculum connectivity influenced cognitive outcomes in both PD (subthalamic nucleus) and AD (fornix) DBS patients (total n = 110). We first confirmed DBS site-subiculum connectivity had opposite cognitive effects in each disease. We next investigated patient factors underlying these opposing effects. Lastly, we related our findings back to clinical practice to guide DBS programming in PD and AD. Results: DBS site-subiculum connectivity correlated with cognitive improvement in AD but decline in PD. This was dependent upon hippocampal atrophy; such that higher subiculum connectivity was beneficial when the hippocampus was atrophic but deleterious when it was intact. Finally, we related our findings back to anatomy with cadaveric dissections and present how DBS stimulation can be optimized to improve patient cognition. Conclusions: DBS site-subiculum connectivity influences cognition but depends on patient factors. Thus, to optimize cognition based on patient factors, DBS electrodes can be programmed to stimulate subregions with higher or lower subiculum connectivity.
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.
Conceptualizations of surge capacity are gaining traction in disaster preparedness and response, particularly in the context of critical and acute care during the pandemic as well as other disaster contexts. In most applications, the surge capacity domains describe the four types of assets required to ensure that surges in demand are addressed. Despite increasing interest and conceptual application, these constructs are yet to be considered or explored in relation to the profound resource scarcity and complex contexts of humanitarian health responses.
Objectives:
The aim of this research is to explore surge capacity domain constructs in the novel context of scarce health resource allocation in humanitarian health care response settings.
Methods:
This research was conducted according to an exploratory qualitative design. Clinicians and managers with relevant experiences were purposively recruited to include broad perspectives across humanitarian responses and clinical specialties. Interview transcripts were analyzed using a latent deductive pattern approach, using a deductive code book consisting of existing surge capacity domains to explore surge capacity constructs. Analysis of coded data for cross-cutting themes drove identification of new findings regarding surge capacity in the context of humanitarian health responses.
Results:
Seventeen participants completed semi-structured interviews. In addition to demonstrating the relevance of existing surge capacity domains (staff, stuff, space, and systems; 4Ss), four new themes emerged: (1) sponsorship; (2) suitability; (3) security; and (4) supply. These four themes informed the conceptualization of surge capacity dimensions which must be satisfied for an asset to render a positive impact with relevance to all four surge capacity domains (4S2 - cumulative 4S domains and the new dimensions).
Conclusions:
Although existing surge capacity domains have proven relevant to humanitarian health care response settings, this research produced a revised conceptualization of surge capacity constructs specific to this context. The identification of four surge capacity dimensions supported the conception and development of the Scarce Health Resource Allocation in Humanitarian Response Settings (SHARE-HRS) 4S2 model of surge capacity, thus offering a potential new tool to support humanitarian health response planning and evaluation.
While scholars document associations between competing parties’ policy disputes and citizens’ cross-party hostility, that is, affective polarization, we lack causal comparative evidence of how different types of ideological disagreements shape partisan affective evaluations. We investigate this issue with a priming experiment across ten Western publics, which prompts some respondents to answer questions inviting them to discuss debates over either cultural or economic issues versus a control group that receives a non-political prompt. Respondents in the economic and cultural priming conditions expressed greater distrust of out-partisans, and, among respondents who received cultural priming, those who discussed immigration in their open-ended responses expressed far more distrust towards opponents – an effect driven by right-wing respondents who discussed immigration. These findings provide comparative evidence that economic and cultural debates cause affective polarization, with immigration as a primary cultural driver.
In paediatric cardiac patients requiring staged palliation, superior cavopulmonary anastomosis is common. Pain control is a crucial aspect of postoperative care as agitation, untreated pain, and hypoventilation can cause increased pulmonary vascular resistance reduction and pulmonary blood flow.
Methods:
This was a large volume single-centre, retrospective cohort study evaluating the impact of gabapentin on opioid and benzodiazepine exposure in infants undergoing superior cavopulmonary anastomosis between January 2018 and December 2022. The primary endpoint was opioid exposure in morphine milligram equivalents per kilogram in infants receiving gabapentin compared to no gabapentin.
Results:
The study analysed 85 infants, 40 of which received perioperative gabapentin. Other than there being more males in the gabapentin group (70% versus 47%; p = 0.03), there was no difference in baseline characteristics. Opioid use, measured in morphine milligram equivalents per kilogram, was similar in the no gabapentin group compared to the gabapentin group during the first 5 POD’s (2.66 (interquartile range1.76, 3.30) versus 2.27 (interquartile range R 1.75, 3.40); p = 0.93. However, there was a lower benzodiazepine exposure, measured in midazolam equivalents per kilogram, in the gabapentin group both on POD 2 (0.05 (interquartile range 0.00, 0.11) versus 0 (interquartile range 0.00, 0.08); p = 0.031) and cumulative (0.15 (interquartile range 0.00, 0.35) versus 0.05 (interquartile range 0.00, 0.15); p = 0.031).
Conclusions:
Gabapentin did not significantly reduce opioid exposure; however, its use was associated with modest reduction in benzodiazepine exposure. There were no differences in adverse events. Our findings suggest gabapentin is safe in infants undergoing superior cavopulmonary anastomosis; however, additional studies should be conducted to evaluate optimal gabapentin dosing.
Ectopic pregnancy is a common gynaecological emergency accounting for a significant proportion of early pregnancy mortality. The chemotherapeutic methotrexate, through targeting rapidly diving cells, is a widely used non-invasive treatment option that has allowed many to avoid invasive surgery. Failure of methotrexate treatment necessitates emergency surgical management, at times to manage haemorrhage related to tubal rupture. As such, careful characterisation, and selection of those suitable for methotrexate treatment is essential. This chapter discusses the use of methotrexate for managing tubal ectopic pregnancy, including eligibility, factors associated with treatment success, and necessary patient counselling. Lastly, we explore the recent advances in knowledge and current landscape of novel therapeutics with potential to improve medical treatment of tubal ectopic pregnancy.
Drawing from the findings on sexual minority and gender diverse (SMGD) concerns and relationships across the 12 countries included in this volume, this chapter provides a summary of the implications for researchers, clinicians, and policymakers. Although the countries are diverse with respect to SMGD-related rights and protections, a review of their results suggests that research focused on the impact of distal minority stressors and structural stigma on the well-being of SGD people is needed. Also, SMGD people continue to experience minority stressors and relationship challenges related to structural stigma and are in need of clinical interventions that are culturally responsive and take into account structural stigma, particularly for the most vulnerable subgroups within SMGD populations (i.e., bisexual, transgender, and gender diverse identified people). Finally, chapter findings have implications for influencing policy, including focusing prevention efforts directly on family and relationship concerns, developing initiatives to reduce minority stress, and strategizing mechanisms to advance SMGD people’s human rights and access to SMGD-affirmative quality care and treatment.
In low- and middle-income countries like Sierra Leone, there is a significant gap in the treatment of perinatal mental health disorders such as anxiety, depression and somatization. This study explored the feasibility, acceptability and preliminary effectiveness of a culturally adapted Problem-Solving Therapy – Friendship Bench Intervention (PST-FBI) delivered by nonspecialists, mother-to-mother support groups (MMSGs), to perinatal women experiencing psychological distress. MMSGs provide 4 weeks of home-based, individual PST-FBI, followed by a peer-led group session called col at sacul (circle of serenity). The intervention targeted peri-urban pregnant women and new mothers screened for psychological distress. This was a two-armed, pre–post, waitlist-controlled study that employed the Sierra Leone Perinatal Psychological Distress Scale (SLPPDS) to screen and measure their outcomes. Feasibility and acceptability were examined through in-depth interviews using the Consolidated Framework for Implementation Research, analyzed thematically, while preliminary effectiveness was evaluated with chi-squared analysis for categorical and t-test for continuous variables. Twenty of the 25 women completed all four PST-FBI sessions delivered by five MMSGs. The individual PST and the peer-led session were viewed as beneficial for problem-sharing and skill building. The SLPPDS scores significantly dropped by 58.9% (17.1–8.4) in the intervention group, while the control group showed a 31.6% (18.0–12.3) decrease. The intervention’s effect size was d = 0.40 (p < 0.05). The MMSG-led PST-FBI, including the col at sacul session, proved feasible, acceptable and with preliminary effectiveness in improving the mental health of peri-urban pregnant women and new mothers in Sierra Leone. Further randomized-controlled trials are recommended before nationwide implementation.
Psychiatric disorders are complex and multifaceted conditions that profoundly impact various aspects of an individual’s life. Although the neurobiology of these disorders is not fully understood, extensive research suggests intricate interactions between genetic factors, changes in brain structure, disruptions in neurotransmitter pathways, as well as environmental influence.
In the case of psychotic disorders, such as schizophrenia, strong genetic components have been identified as a key feature in the development of psychosis. Moreover, alterations in dopamine function and structural brain changes that result in volume loss seem to be pervasive in people affected by these disorders. Meanwhile, mood disorders, including major depressive disorder and bipolar disorder, are characterized by disruptions in neurotransmitter systems responsible for mood regulation, such as serotonin, norepinephrine, and dopamine. Anxiety and personality disorders also exhibit neurotransmitter dysfunction and neuroanatomical changes, in addition to showing a genetic overlap with mood and psychotic disorders.
Understanding the underlying mechanisms in the pathophysiology of these conditions is of paramount importance and involves integrating findings from various research areas, including at the molecular and cellular levels. This brief overview aims to highlight some of the important developments in our current understanding of psychiatric disorders. Future research should aim to incorporate a comprehensive approach to further unravel the complexity of these disorders and pave the way for targeted therapeutic strategies and effective treatments to improve the lives of individuals afflicted by them.
The lifetime prevalence of PTSD ranges from 6 to 20% and is often associated with comorbid disorders. Despite the significant impact of PTSD, specific data on healthcare utilization related to PTSD remain limited. This study aims to characterize PTSD-related hospitalizations in France over the past decade.
Methods
This nationwide longitudinal retrospective study analyzed PTSD-related hospitalizations in France from 2013 to 2022 using the French National Hospitals Database. Data included discharge records from general and psychiatric hospitals, detailing demographics, admission/discharge dates, ICD-10 diagnoses, and hospitalization specifics.
Results
Between 2013 and 2022, 69,108 patients underwent 125,349 hospitalizations with a PTSD diagnosis (0.4% of all inpatient cases) in France. Psychiatric facilities accounted for 74,988 hospitalizations (1% of all psychiatric inpatient cases in France), while general hospitals recorded 50,361 hospitalizations (0.02% of all non-psychiatric inpatient cases). The percentage of inpatients diagnosed with PTSD increased from 0.68 to 2.22% in psychiatric facilities and from 0.02 to 0.04% in general hospitals over the study period. Females were younger in both settings and had longer stays compared to males in psychiatric facilities. Over time, there was a decrease in median age and an increase in part-time hospitalizations in psychiatric facilities. Mood disorders, stress-related disorders, and substance use disorders were prevalent comorbidities in both settings.
Conclusions
This study highlights a rise in PTSD-related hospitalizations in France, particularly in psychiatric facilities and after 2019, with high rates among women and an increase in hospitalization of younger individuals. These findings highlight the necessity for improved care strategies tailored to the increasing number of younger patients with PTSD.
This study aimed to investigate the prevalence and nature of cognitive impairment among severely ill COVID-19 patients and the effectiveness of the Montreal Cognitive Assessment (MoCA) in detecting it.
Method:
We evaluated cognition in COVID-19 patients hospitalized during the first wave (March to June 2020) from six Dutch hospitals, nine months post-discharge, using a comprehensive multi-domain neuropsychological test battery. Test performance was corrected for sex, age, and education differences and transformed into z-scores. Scores within each cognitive domain were averaged and categorized as average and above (z-score ≥ −0.84), low average (z-score −1.28 to −0.84), below average (z-score −1.65 to −1.28), and exceptionally low (z-score < −1.65). Patients were classified with cognitive impairment if at least one domain’s z-score fell below −1.65. We assessed the MoCA’s accuracy using both the original cutoff (<26) and an “optimal” cutoff determined by Youden’s index.
Results:
Cognitive impairment was found in 12.1% (24/199) of patients, with verbal memory and mental speed most affected (6.5% and 7% below −1.65, respectively). The MoCA had an area under the curve of 0.84. The original cutoff showed sensitivity of 83% and specificity of 66%. Using the identified optimal cutoff of <24, maintained sensitivity while improving specificity to 81%.
Conclusions:
Cognitive impairment prevalence in initially hospitalized COVID-19 patients is lower than initially expected. Verbal memory and processing speed are primarily affected. The MoCA is a valuable screening tool for these impairments and lowering the MoCA cutoff to <24 improves specificity.
It is suggested that if Guttman’s latent-root-one lower bound estimate for the rank of a correlation matrix is accepted as a psychometric upper bound, following the proofs and arguments of Kaiser and Dickman, then the rank for a sample matrix should be estimated by subtracting out the component in the latent roots which can be attributed to sampling error, and least-squares “capitalization” on this error, in the calculation of the correlations and the roots. A procedure based on the generation of random variables is given for estimating the component which needs to be subtracted.
Despite 30 years of research on economic inequality, the question of whether government ideology affects inequality remains unresolved. As rising inequality poses a major challenge to contemporary democracies, we ask: (when) do parties matter regarding inequality? Our systematic analysis finds that research is divided, with a tendency toward a pessimistic “no.” We decipher the factors that account for this split in theoretically predictable ways. We assess the roles played by the type of inequality, the time horizon, and the impact of policy channels. Bivariate and multivariate analyses of 393 TSCS-regression findings show how the type of inequality and a neglect of top incomes, a focus on short- rather than long-term effects, and the inclusion of policy channels that absorb the effects of parties strongly codetermine the results. Effects septuple depending on how these factors are combined. We draw three lessons that, when combined, foster a shift toward a more optimistic perspective on the latitude of politics.
Provides a multi-scalar synthesis of Nordic Bronze Age economies (1800/1700–500 BCE) that is organized around six sections: an introduction to the Nordic Bronze Age, macro-economic perspectives, defining local communities, economic interaction, conflict and alliances, political formations, and encountering Europe. Despite a unifying material culture, the Bronze Age of Scandinavia was complex and multi- layered with constantly shifting and changing networks of competitors and partners. The social structure in this highly mobile and dynamic macroregional setting was affected by subsistence economies based on agropastoralism, maritime sectors, the production of elaborate metal wealth, trade in a wide range of goods, as well as raiding and warfare. For this reason, the focus of this book is on the integration and interaction of subsistence and political economies in a comparative analyses between different local constellations within the macro-economic setting of prehistoric Europe. This title is also available as Open Access on Cambridge Core
Next generation high-power laser facilities are expected to generate hundreds-of-MeV proton beams and operate at multi-Hz repetition rates, presenting opportunities for medical, industrial and scientific applications requiring bright pulses of energetic ions. Characterizing the spectro-spatial profile of these ions at high repetition rates in the harsh radiation environments created by laser–plasma interactions remains challenging but is paramount for further source development. To address this, we present a compact scintillating fiber imaging spectrometer based on the tomographic reconstruction of proton energy deposition in a layered fiber array. Modeling indicates that spatial resolution of approximately 1 mm and energy resolution of less than 10% at proton energies of more than 20 MeV are readily achievable with existing 100 μm diameter fibers. Measurements with a prototype beam-profile monitor using 500 μm fibers demonstrate active readouts with invulnerability to electromagnetic pulses, and less than 100 Gy sensitivity. The performance of the full instrument concept is explored with Monte Carlo simulations, accurately reconstructing a proton beam with a multiple-component spectro-spatial profile.
Archaeological sites in Northwest Africa are rich in human fossils and artefacts providing proxies for behavioural and evolutionary studies. However, these records are difficult to underpin on a precise chronology, which can prevent robust assessments of the drivers of cultural/behavioural transitions. Past investigations have revealed that numerous volcanic ash (tephra) layers are interbedded within the Palaeolithic sequences and likely originate from large volcanic eruptions in the North Atlantic (e.g. the Azores, Canary Islands, Cape Verde). Critically, these ash layers offer a unique opportunity to provide new relative and absolute dating constraints (via tephrochronology) to synchronise key archaeological and palaeoenvironmental records in this region. Here, we provide an overview of the known eruptive histories of the potential source volcanoes capable of widespread ashfall in the region during the last ~300,000 years, and discuss the diagnostic glass compositions essential for robust tephra correlations. To investigate the eruption source parameters and weather patterns required for ash dispersal towards NW Africa, we simulate plausible ashfall distributions using the Ash3D model. This work constitutes the first step in developing a more robust tephrostratigraphic framework for distal ash layers in NW Africa and highlights how tephrochronology may be used to reliably synchronise and date key climatic and cultural transitions during the Palaeolithic.