This editorial considers the value and nature of academic psychiatry by asking what defines the specialty and psychiatrists as academics. We frame academic psychiatry as a way of thinking that benefits clinical services and discuss how to inspire the next generation of academics.

Antarctica was once considered biologically isolated, surrounded by oceanic barriers (Fraser et al. 2018). However, floating materials such as kelp rafts (Fraser et al. 2018, Avila et al. 2020), wood (Lewis et al. 2005) and plastics (Avila et al. 2020) are now known to cross these barriers and reach Antarctic shores. Such incursions might enable non-native species (either rafting species themselves or associated hitchhikers) to colonize Antarctica as the climate warms (Avila et al. 2020, Fraser et al. 2020), but whether these species will be able to survive and reproduce in the Antarctic is not yet known. Sea ice is a defining characteristic of Antarctic coastlines, and modelled trajectories of kelp rafts (Fraser et al. 2018) cross-referenced against sea-ice observations (Parkinson 2019) suggest that collisions between rafts and seasonal sea ice occur frequently (Fig. 1a); thus, rafts are expected to be entrained in, on or under sea ice and experience multiple freeze-and-thaw cycles on their journeys to Antarctica. In addition, kelp rafts that reach the Antarctic intertidal will experience temperatures well below 0°C if exposed to the air at low tide. Freezing can cause severe disruptive stress to seaweeds, and ice crystals growing in intercellular spaces can damage cell membranes and cause cell lysis (Eggert 2012). Such damage could affect the buoyancy of kelp tissue and decrease rafting ability. Although some non-native kelp rafts recovered from Antarctic shores appeared to still be reproductively viable, with mature gametes observed in reproductive tissue (Fraser et al. 2018), tissue damage caused by freezing could have widespread effects on the health, function and establishment success of a non-native species traversing the Southern Ocean.

Root cause analysis (RCA), imported from high-reliability industries into health two decades ago, is the mandated methodology to investigate adverse events in most health systems. In this analysis, we argue that the validity of RCA in health and in psychiatry must be established, given the impact of these investigations on mental health policy and practice.

Understanding cross-cultural differences in attitudes to animal welfare issues is important in maintaining good international relations, including economic and trade relations. This study aimed to investigate the attitudes of stakeholders towards improving the welfare of animals during slaughter and transport in four key SE and E Asian countries: China, Thailand, Vietnam and Malaysia. Logistic regression analysis of the associations between demographic factors and attitudes identified nationality as the most significant factor influencing attitude. Motivating factors for improving welfare were ranked according to their importance: religion, knowledge levels, monetary gain, availability of tools and resources, community issues, approval of supervisor and peers. Strong beliefs in the influence of animal welfare laws, the power of the workplace and the importance of personal knowledge were shared by all countries. In addition, religion and peer consideration were significantly associated with attitudes in Malaysia and Thailand, respectively. The findings of this research will assist in the development of international animal welfare initiatives.

Although long-term outcomes of girls with attention-deficit hyperactivity disorder are understudied, high risk for adolescent and young-adult self-harm is salient. We present data on predictors and mediators of such risk, highlighting a recent dual-process model involving trait impulsivity plus family- and peer-related contributors. We conclude with recommendations for assessment and preventive intervention.

Introduction: Prehospital field trauma triage (FTT) standards were reviewed and revised in 2014 based on the recommendations of the Centers for Disease Control and Prevention. The FTT standard allows a hospital bypass and direct transport, within 30 min, to a lead trauma hospital (LTH). Our objectives were to assess the impact of the newly introduced prehospital FTT standard and to describe the emergency department (ED) management and outcomes of patients that had bypassed closer hospitals. Methods: We conducted a 12-month multi-centred health record review of paramedic and ED records following the implementation of the 4 step FTT standard (step 1: vital signs and level of consciousness (physiologic), step 2: anatomical injury, step 3: mechanism and step 4: special considerations) in nine paramedic services across Eastern Ontario. We included adult trauma patients transported as urgent that met FTT standard, regardless of transport time. We developed and piloted a data collection tool and obtained consensus on all definitions. The primary outcome was the rate of appropriate triage to a LTH which was defined as: ISS ≥12, admitted to intensive care unit (ICU), non-orthopedic surgery, or death. We have reported descriptive statistics. Results: 570 patients were included: mean age 48.8, male 68.9%, falls 29.6%, motor vehicle collisions 20.2%, stab wounds 10.5%, transported to a LTH 76.5% (n = 436). 72.2% (n = 315) of patients transported to a LTH had bypassed a closer hospital and 126/306 (41.2%) of those were determined to be an appropriate triage to LTH (9 patients had missing outcomes). ED management included: CT head/cervical spine 69.9%, ultrasound 53.6%, xray 51.6%, intubation 15.0%, sedation 11.1%, tranexamic acid 9.8%, blood transfusion 8.2%, fracture reduction 6.9%, tube thoracostomy 5.9%. Outcomes included: ISS ≥ 12 32.7%, admitted to ICU 15.0%, non-orthopedic surgery 11.1%, death 8.8%. Others included: admission to hospital 57.5%, mean LOS 12.8 days, orthopedic surgery 16.3% and discharged from ED 37.3%. Conclusion: Despite a high number of admissions, the majority of trauma patients bypassed to a LTH were considered over-triaged, with a low number of ED procedures and non-orthopedic surgeries. Continued work is needed to appropriately identify patients requiring transport to a LTH.

Alcohol use disorders (AUD) are common, particularly in patients attending mental health services. Clinicians are often hesitant to explore with patients their relationship with alcohol and the role that it has in their presenting complaint, despite being ideally placed to optimise on a ‘teachable moment’ and initiate treatment, where necessary. This article provides an overview of AUD and their identification and management options.

Introduction: Trauma and injury play a significant role in the population's burden of disease. Limited research exists evaluating the role of trauma bypass protocols. The objective of this study was to assess the impact and effectiveness of a newly introduced prehospital field trauma triage (FTT) standard, allowing paramedics to bypass a closer hospital and directly transport to a trauma centre (TC) provided transport times were within 30 minutes. Methods: We conducted a 12-month multi-centred health record review of paramedic call reports and emergency department health records following the implementation of the 4 step FTT standard (step 1: vital signs and level of consciousness, step 2: anatomical injury, step 3: mechanism and step 4: special considerations) in nine paramedic services across Eastern Ontario. We included adult trauma patients transported as an urgent transport to hospital, that met one of the 4 steps of the FTT standard and would allow for a bypass consideration. We developed and piloted a standardized data collection tool and obtained consensus on all data definitions. The primary outcome was the rate of appropriate triage to a TC, defined as any of the following: injury severity score ≥12, admitted to an intensive care unit, underwent non-orthopedic operation, or death. We report descriptive and univariate analysis where appropriate. Results: 570 adult patients were included with the following characteristics: mean age 48.8, male 68.9%, attended by Advanced Care Paramedic 71.8%, mechanisms of injury: MVC 20.2%, falls 29.6%, stab wounds 10.5%, median initial GCS 14, mean initial BP 132, prehospital fluid administered 26.8%, prehospital intubation 3.5%, transported to a TC 74.6%. Of those transported to a TC, 308 (72.5%) had bypassed a closer hospital prior to TC arrival. Of those that bypassed a closer hospital, 136 (44.2%) were determined to be “appropriate triage to TC”. Bypassed patients more often met the step 1 or step 2 of the standard (186, 66.9%) compared to the step 3 or step 4 (122, 39.6%). An appropriate triage to TC occurred in 104 (55.9%) patients who had met step 1 or 2 and 32 (26.2%) patients meeting step 3 or 4 of the FTT standard. Conclusion: The FTT standard can identify patients who should be bypassed and transported to a TC. However, this is at a cost of potentially burdening the system with poor sensitivity. More work is needed to develop a FTT standard that will assist paramedics in appropriately identifying patients who require a trauma centre.

After Mexican sugar producers gained unlimited, tariff-free access to the U.S. market in 2008, U.S. and Mexican governments bilaterally agreed to constrain Mexico’s sugar exports to the United States because of dumping allegations by U.S. producers in December 2014. This analysis employs a dynamic partial equilibrium model to estimate the price and welfare impacts of the U.S.-Mexico agreement by simulating the reimplementation of North American Free Trade Agreement sugar policies. Estimates suggest liberalizing the market would decrease U.S. sugar prices, translating to an average annual decrease in producer surplus of approximately $660 million and increase in consumer surplus of $1.67 billion across the simulation.