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Compulsive-like rigidity may be associated with hyposerotonergia and increased kynurenine (KYN) pathway activity. Conversion of tryptophan (TRP) to KYN, which may contribute to hyposerotonergia, is bolstered by inflammation and could be related to altered gut microbiota composition. Here, we studied these mechanisms in a naturalistic animal model of compulsive-like behavioural rigidity, that is, large nest building (LNB) in deer mice (Peromyscus sp.).
Methods:
Twenty-four (24) normal nest building (NNB) and 24 LNB mice (both sexes) were chronically administered either escitalopram (a selective serotonin reuptake inhibitor; 50 mg/kg/day) or a control solution, with nesting behaviour analysed before and after intervention. After endpoint euthanising, frontal cortices and striata were analysed for TRP and its metabolites, plasma for microbiota-derived lipopolysaccharide (LPS) and its binding protein (lipopolysaccharide binding protein), and stool samples for microbial DNA.
Results:
LNB, but not NNB, decreased after escitalopram exposure. At baseline, LNB was associated with reduced frontal cortical TRP concentrations and hyposerotonergia that was unrelated to altered KYN pathway activity. In LNB mice, escitalopram significantly increased frontal-cortical and striatal TRP without altering serotonin concentrations. Treated LNB, compared to untreated LNB and treated NNB mice, had significantly reduced plasma LPS as well as a microbiome showing a decreased inferred potential to synthesise short-chain fatty acids and degrade TRP.
Conclusions:
These findings support the role of altered serotonergic mechanisms, inflammatory processes, and gut microbiome involvement in compulsive-like behavioural rigidity. Our results also highlight the importance of gut-brain crosstalk mechanisms at the level of TRP metabolism in the spontaneous development of such behaviour.
This paper explores the intersection of physical health and recovery-oriented approaches in psychosis, offering a unique perspective through autoethnography. By combining personal experience with a broader analysis of existing mental health frameworks, the paper highlights the often overlooked importance of physical health in the recovery process for individuals with psychosis. The autoethnographic narrative reveals the complex challenges posed by antipsychotic medications, including weight gain and metabolic complications, and their impact on overall well-being. It emphasizes the dual stigma of mental health challenges and weight gain, highlighting the need for a more integrated, holistic approach to mental health care. Recommendations include enhanced education for healthcare providers, personalized care plans, and a multidisciplinary approach aimed at bridging the gap between physical and mental health in psychosis recovery.
Borsboom (2006) attacks psychologists for failing to incorporate psychometric advances in their work, discusses factors that contribute to this regrettable situation, and offers suggestions for ameliorating it. This commentary applauds Borsboom for calling the field to task on this issue and notes additional problems in the field regarding measurement that he could add to his critique. It also chastises Borsboom for occasionally being unnecessarily perjorative in his critique, noting that negative rhetoric is unlikely to make converts of offenders. Finally, it exhorts psychometricians to make their work more accessible and points to Borsboom, Mellenbergh, and Van Heerden (2003) as an excellent example of how this can be done.
Representation scholarship has drawn from intersectionality theory 0to examine how systemic structures of oppression and privilege have created social groups with distinct political needs. Derived from Black feminist theory that recognizes that identities are mutually constitutive and interconnected, intersectionality research is rooted in the lived experiences of marginalized groups who call attention to social (in)justice. Empirical scholarship building on the insights of Black feminist theorists such as Collins and Bilge (2016), Hill Collins (1990), Crenshaw (1989; 1991), and King (1988) has constituted nothing less than a paradigm shift in the study of gender and politics. Nevertheless, there remain an array of opportunities to expand upon the potential for intersectional frameworks and methods, as well as pressing new questions concerning the operationalization of intersectionality itself. This Critical Perspectives section offers a moment to take stock of these developments and debates, as well as to highlight new pathways for scholarship committed to centering the margins and considering the nexus of multiple power structures that frame our political lives.
This contribution takes stock of the growing research on deindustrialization from a gender perspective. Much of the work in deindustrialization studies is rooted in local studies, within single national contexts. This article provides a perspective that cuts across case studies and national historiographies. It reviews findings on the implications of deindustrialization for working-class masculinities and considers the extent to which research has privileged a focus on white masculinity in crisis (a theme which is more present in some national contexts than others). The article goes on to show how a more complex and nuanced understanding of gender, class, and race is emerging. It highlights women workers’ experience of deindustrialization and considers the ways in which deindustrialization is associated with a restructuring of gender relations. Acknowledging some of the limitations of the current state of research, the article points to a number of potential avenues for further enquiry.
Research on the Alternative DSM-5 Model for Personality Disorders (AMPD) in DSM-5's Section-III has demonstrated acceptable interrater reliability, a largely consistent latent structure, substantial correlations with theoretically and clinically relevant measures, and evidence for incremental concurrent and predictive validity after controlling for DSM-5's Section II categorical personality disorders (PDs). However, the AMPD is not yet widely used clinically. One clinician concern may be caseness – that the new model will diagnose a different set of PD patients from that with which they are familiar. The primary aim of this study is to determine whether this concern is valid, by testing how well the two models converge in terms of prevalence and coverage.
Method
Participants were 305 psychiatric outpatients and 302 community residents not currently in mental-health treatment who scored above threshold on the Iowa Personality Disorder Screen (Langbehn et al., 1999). Participants were administered a semi-structured interview for DSM-5 PD, which was scored for both Section II and III PDs.
Results
Convergence across the two PD models was variable for specific PDs, Good when specific PDs were aggregated, and Very Good for ‘any PD.’
Conclusions
Results provide strong evidence that the AMPD yields the same overall prevalence of PD as the current model and, further, identifies largely the same overall population. It also addresses well-known problems of the current model, is more consistent with the ICD-11 PD model, and provides more complete, individualized characterizations of persons with PD, thereby offering multiple reasons for its implementation in clinical settings.
To investigate the symptoms of SARS-CoV-2 infection, their dynamics and their discriminatory power for the disease using longitudinally, prospectively collected information reported at the time of their occurrence. We have analysed data from a large phase 3 clinical UK COVID-19 vaccine trial. The alpha variant was the predominant strain. Participants were assessed for SARS-CoV-2 infection via nasal/throat PCR at recruitment, vaccination appointments, and when symptomatic. Statistical techniques were implemented to infer estimates representative of the UK population, accounting for multiple symptomatic episodes associated with one individual. An optimal diagnostic model for SARS-CoV-2 infection was derived. The 4-month prevalence of SARS-CoV-2 was 2.1%; increasing to 19.4% (16.0%–22.7%) in participants reporting loss of appetite and 31.9% (27.1%–36.8%) in those with anosmia/ageusia. The model identified anosmia and/or ageusia, fever, congestion, and cough to be significantly associated with SARS-CoV-2 infection. Symptoms’ dynamics were vastly different in the two groups; after a slow start peaking later and lasting longer in PCR+ participants, whilst exhibiting a consistent decline in PCR- participants, with, on average, fewer than 3 days of symptoms reported. Anosmia/ageusia peaked late in confirmed SARS-CoV-2 infection (day 12), indicating a low discrimination power for early disease diagnosis.
We recently reported on the radio-frequency attenuation length of cold polar ice at Summit Station, Greenland, based on bi-static radar measurements of radio-frequency bedrock echo strengths taken during the summer of 2021. Those data also allow studies of (a) the relative contributions of coherent (such as discrete internal conducting layers with sub-centimeter transverse scale) vs incoherent (e.g. bulk volumetric) scattering, (b) the magnitude of internal layer reflection coefficients, (c) limits on signal propagation velocity asymmetries (‘birefringence’) and (d) limits on signal dispersion in-ice over a bandwidth of ~100 MHz. We find that (1) attenuation lengths approach 1 km in our band, (2) after averaging 10 000 echo triggers, reflected signals observable over the thermal floor (to depths of ~1500 m) are consistent with being entirely coherent, (3) internal layer reflectivities are ≈–60$\to$–70 dB, (4) birefringent effects for vertically propagating signals are smaller by an order of magnitude relative to South Pole and (5) within our experimental limits, glacial ice is non-dispersive over the frequency band relevant for neutrino detection experiments.
Does providing information about police shootings influence policing reform preferences? We conducted an online survey experiment in 2021 among approximately 2,600 residents of 10 large US cities. It incorporated original data we collected on police shootings of civilians. After respondents estimated the number of police shootings in their cities in 2020, we randomized subjects into three treatment groups and a control group. Treatments included some form of factual information about the police shootings in respondents’ cities (e.g., the actual total number). Afterward, respondents were asked their opinions about five policing reform proposals. Police shooting statistics did not move policing reform preferences. Support for policing reforms is primarily associated with partisanship and ideology, coupled with race. Our findings illuminate key sources of policing reform preferences among the public and reveal potential limits of information-driven, numeric-based initiatives to influence policing in the US.
In 1831, Anne Lister wrote that she ‘found distinctly for the first time’ her own clitoris. This culminated a search of at least eleven years, involving much exploration of her own and her female lovers’ anatomy. Of course, her explicit diaries made clear that she touched her own and her lovers’ clitorises, but she was not able to link her own sensations with the anatomical terms she found in textbooks. By looking at Lister’s quest to find the clitoris, we can understand in more detail how difficult it was for women to conceptualise this important part of their bodies. If Anne Lister, a brilliant, erudite woman very knowledgeable about science and anatomy, and very sexually experienced with women, took so long to figure it out, it must have been much more difficult for ordinary women. The most startling aspect of how discourses could affect perception was that Lister spent ten years confusing the clitoris with the cervix, leading to fruitless explorations of her own body and those of her lovers. This chapter will thus contribute to the larger historiography about the history of the clitoris - when it appeared in anatomical books, and when some medical texts started to downplay or omit it.
Global Emergency Care Skills (GECS) is a charity which delivers medical training to health care professionals in low and middle income countries. Teaching airway management both didactically and through simulation training is a key component of the GECS Emergencies and Trauma Course. In 2022, a team of doctors delivered an intensive, five-day teaching course with a strong emphasis on airway management and airway emergencies at St. Joseph’s Nyabondo Mission Hospital in rural Kenya. This course was delivered to a group of doctors, nurses and clinical officers. At the conclusion of this course we collected qualitative feedback from course participants. The aim of this study was to assess airway knowledge and skills acquisition, as well as real-world application and potential for ongoing teaching of acquired airway skills.
Method:
A questionnaire was distributed to course participants to ascertain their experience of didactic airway teaching, airway skills stations, and airway simulation. Each question offered a binary response. To continue to enhance course content, we invited participants to submit qualitative feedback at the end of the questionnaire.
Results:
Questionnaires were returned by 19 of a total 24 participants. 53% were registered nurses, 21% were clinical officers, 5% were medical officers and 21% did not respond to this question. Median post graduate clinical experience was four years (2.75-5.25). 37% indicated that they had not heard of simulation training for medical education before undertaking this course. 58% had no previous airway training although 63% had prior exposure to clinical situations which required emergency airway management. 100% reported feeling more confident in their airway skills and potential for training colleagues following this course.
Conclusion:
The results indicate that participants gained knowledge, skills, and confidence when approaching airway emergencies. Furthermore, results showed increased perceived competence by participants at providing airway training to colleagues.
Black women in elective office in the United States have demonstrated how descriptive representative transforms democratic institutions. This transformation is most evident in previously uncrystallized interests, those new to the agenda or not yet owned by specific political groups (Mansbridge 1999), articulated in legislative communication and action. For instance, Black maternal health is an issue that addresses the disproportionately poor health outcomes among Black women, who face systemic barriers to equitable care (Crear-Perry et al. 2021). Congresswoman Lauren Underwood’s (D-IL) 2021 Momnibus legislation included 12 bipartisan bills to address racial and ethnic disparities faced by mothers, children, and individuals who birth. Indeed, the creation of the Black Maternal Health Caucus (BMHC) demonstrates the legislative agency of Black women to form identity- and issue-based coalitions that suit the needs of Black women—needs often overlooked by Black men and white women.
Ensuring continuity of care for patients with major depressive disorders poses multiple challenges. We conducted a systematic review and meta-analysis of randomised controlled trials comparing real-time telehealth to face-to-face therapy for individuals with depression. We searched Medline, Embase, and Cochrane Central (to November 2020), conducted a citation analysis (January 2021), and searched clinical trial registries (March 2021). We included randomised controlled trials comparing similar or identical care, delivered via real-time telehealth (phone, video) to face-to-face. Outcomes included: depression severity, quality of life, therapeutic alliance, and care satisfaction. Where data were sufficient, mean differences were calculated. Nine trials (1268 patients) were included. There were no differences between telehealth and face-to-face care for depression severity at post-treatment (SMD −0.04, 95% CI −0.21 to 0.13, p = 0.67) or at other time points, except at 9 months post-treatment (SMD −0.39, 95% CI −0.75 to −0.02, p = 0.04). One trial reported no differences in quality-of-life scores at 3- or 12-months post-treatment. One trial found no differences in therapeutic alliance at weeks 4 and 14 of treatment. There were no differences in treatment satisfaction between telehealth and face-to-face immediately post-treatment (SMD −0.14, 95% CI −0.56 to 0.28, p = 0.51) or at 3 or 12-months. Evidence suggests that for patients with depression or depression symptoms, the provision of care via telehealth may be a viable alternative to the provision of care face-to-face. However, additional trials are needed with longer follow-up, conducted in a wider range of settings, and with younger patients.
Major physiological changes occur in the maternal cardiovascular system during pregnancy. In women with pre-existing or previously undiagnosed cardiac disease, these changes may precipitate cardiac decompensation. The number of women with heart disease embarking on a pregnancy is increasing. Heart disease is the commonest cause of maternal death in the UK where all maternal deaths are critically reviewed. In approximately half of the women who died from cardiac disease in the UK, suboptimal care was identified. In the Netherlands, the maternal mortality rate from cardiac disease (2004–2006) was 3 per 100 000 maternities. Multidisciplinary teams working and co-location of clinical services are critically important to ensure the best care possible for pregnant women with cardiac conditions (Figure 28.1).
Hearing voices is a distressing and trans-diagnostic experience. Cognitive behavioural therapy (CBT) is an effective psychological treatment for distressing voices, but is offered to only a minority of patients. Limited resources are a barrier to accessing CBT. Evaluations of brief forms of CBT for voices have offered encouraging findings, but the ability of briefly-trained therapists to deliver these brief therapies has yet to be explored. We evaluated the outcomes of a brief form of CBT (Coping Strategy Enhancement, CSE) for voices when delivered by highly-trained and briefly-trained therapists. This was a service evaluation comparing pre–post outcomes in patients who had completed brief CSE over four sessions, within NHS Mental Health Services, delivered by highly-trained and briefly-trained therapists. The primary outcome was the negative impact scale of the Hamilton Program for Schizophrenia Voices Questionnaire. Data were available from 92 patients who completed a course of brief CSE – nearly half of whom received therapy from a briefly-trained therapist. Modest benefits across the sample were consistent with previous evaluations and did not seem to be influenced by the training of the therapist. This service evaluation offers further evidence that brief CSE can begin a therapeutic conversation about distressing voices within routine clinical practice. The usefulness of this initial conversation does not seem to be reliant upon the extent of therapist training, suggesting that briefly-trained therapists may play a role in increasing access to these conversations for patients distressed by hearing voices.
Key learning aims
(1) How can access to CBT be increased for patients distressed by hearing voices?
(2) Can a wider workforce of briefly-trained therapists start a CBT-informed conversation about distressing voices?
(3) How do the outcomes of these conversations compare with the same conversations facilitated by highly trained therapists?
We summarize some of the past year's most important findings within climate change-related research. New research has improved our understanding of Earth's sensitivity to carbon dioxide, finds that permafrost thaw could release more carbon emissions than expected and that the uptake of carbon in tropical ecosystems is weakening. Adverse impacts on human society include increasing water shortages and impacts on mental health. Options for solutions emerge from rethinking economic models, rights-based litigation, strengthened governance systems and a new social contract. The disruption caused by COVID-19 could be seized as an opportunity for positive change, directing economic stimulus towards sustainable investments.
Technical summary
A synthesis is made of ten fields within climate science where there have been significant advances since mid-2019, through an expert elicitation process with broad disciplinary scope. Findings include: (1) a better understanding of equilibrium climate sensitivity; (2) abrupt thaw as an accelerator of carbon release from permafrost; (3) changes to global and regional land carbon sinks; (4) impacts of climate change on water crises, including equity perspectives; (5) adverse effects on mental health from climate change; (6) immediate effects on climate of the COVID-19 pandemic and requirements for recovery packages to deliver on the Paris Agreement; (7) suggested long-term changes to governance and a social contract to address climate change, learning from the current pandemic, (8) updated positive cost–benefit ratio and new perspectives on the potential for green growth in the short- and long-term perspective; (9) urban electrification as a strategy to move towards low-carbon energy systems and (10) rights-based litigation as an increasingly important method to address climate change, with recent clarifications on the legal standing and representation of future generations.
Social media summary
Stronger permafrost thaw, COVID-19 effects and growing mental health impacts among highlights of latest climate science.
Anna Clark's presidential plenary to the 2018 North American Conference on British Studies in Vancouver, British Columbia, compares scandals over the mistreatment of patients and nurses that led to demands for popular control of hospitals in both Britain and New Zealand in the 1890s. A high death rate at the Chelsea Hospital for Women in London, located near a Pasteur Institute for animal research on vaccination, incited fears of human vivisection. The high death rate of nurses at the London Hospital provoked newspaper exposés and parliamentary investigations and calls for the municipalization of voluntary hospitals. In Christchurch, New Zealand, a debate over the rudeness of doctors and nurses enraged citizens. The flames of these scandals were sparked by newspaper agitation but fanned by feminists, socialists, trade unionists, and animal-rights organizations. In response to fears around experimentation, Fabian socialists Havelock Ellis, Harry Roberts, and Honnor Morten proposed democratic control of hospitals. These demands, focusing on patients’ rights and nurses’ health, differed from the hospital reform movement that urged hospitals to become more economical by forcing patients to pay. They also diverged from Beatrice and Sidney Webb's admonitions that the state must oversee citizens’ health for the nation to function efficiently. Although the calls for the democratic control of hospitals did not succeed, they might be seen as germs of a patient-centered approach to hospital care.
Advanced imaging techniques are enhancing research capacity focussed on the developmental origins of adult health and disease (DOHaD) hypothesis, and consequently increasing awareness of future health risks across various subareas of DOHaD research themes. Understanding how these advanced imaging techniques in animal models and human population studies can be both additively and synergistically used alongside traditional techniques in DOHaD-focussed laboratories is therefore of great interest. Global experts in advanced imaging techniques congregated at the advanced imaging workshop at the 2019 DOHaD World Congress in Melbourne, Australia. This review summarizes the presentations of new imaging modalities and novel applications to DOHaD research and discussions had by DOHaD researchers that are currently utilizing advanced imaging techniques including MRI, hyperpolarized MRI, ultrasound, and synchrotron-based techniques to aid their DOHaD research focus.