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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.
The law and corpus linguistics movement shares many of the commitments of experimental jurisprudence. Both are concerned with testing intuitions about legal concepts through the lens of empirical evidence gathered through experimentation. Though often discussed in the context of a given case or legal problem, linguistic evidence from legal corpora can help provide content to otherwise indeterminate concepts in the law.
Using language evidence from linguistic corpora, we can begin to have more meaningful conversations about what concepts like ordinary meaning, ambiguity, and speech community might actually mean and make progress on the boundaries of these concepts and their implications for legal interpretation. And, because corpora are constructed from linguistic utterances made in natural linguistic settings, they can provide an important check and means of triangulation for experimental jurisprudence claims that are often premised on survey data.
In this chapter of Complex Ethics Consultations: Cases that Haunt Us, the authors describe a baby born at 25 weeks gestational age (at a time when survival at that stage was tenuous) to an adolescent mother. The fragile preemie developed necrotizing enterocolitis that was so extensive that definitive surgical resection was impossible. With no definitive treatment and inevitable suffering without it, the recommendation to shift to comfort care was declined and ethics consultants helped to negotiate the conflict.
The stars of the Milky Way carry the chemical history of our Galaxy in their atmospheres as they journey through its vast expanse. Like barcodes, we can extract the chemical fingerprints of stars from high-resolution spectroscopy. The fourth data release (DR4) of the Galactic Archaeology with HERMES (GALAH) Survey, based on a decade of observations, provides the chemical abundances of up to 32 elements for 917 588 stars that also have exquisite astrometric data from the Gaia satellite. For the first time, these elements include life-essential nitrogen to complement carbon, and oxygen as well as more measurements of rare-earth elements critical to modern-life electronics, offering unparalleled insights into the chemical composition of the Milky Way. For this release, we use neural networks to simultaneously fit stellar parameters and abundances across the whole wavelength range, leveraging synthetic grids computed with Spectroscopy Made Easy. These grids account for atomic line formation in non-local thermodynamic equilibrium for 14 elements. In a two-iteration process, we first fit stellar labels to all 1 085 520 spectra, then co-add repeated observations and refine these labels using astrometric data from Gaia and 2MASS photometry, improving the accuracy and precision of stellar parameters and abundances. Our validation thoroughly assesses the reliability of spectroscopic measurements and highlights key caveats. GALAH DR4 represents yet another milestone in Galactic archaeology, combining detailed chemical compositions from multiple nucleosynthetic channels with kinematic information and age estimates. The resulting dataset, covering nearly a million stars, opens new avenues for understanding not only the chemical and dynamical history of the Milky Way but also the broader questions of the origin of elements and the evolution of planets, stars, and galaxies.
To evaluate the impact of implementing a multi-step Clostridioides difficile infection (CDI) testing algorithm on hospital-onset (HO)-CDI rates and clinical outcomes.
Two academic hospitals in Pittsburgh, Pennsylvania.
Methods:
In the pre-intervention period, a standalone polymerase chain reaction (PCR) assay was used for diagnosing CDI. In the post-intervention period, positive PCR assays were reflexed to a glutamate dehydrogenase antigen test and an enzyme immunoassay for toxin A/B.
Results:
The implementation of a multi-step testing algorithm resulted in a significant reduction in HO-CDI cases per 10,000 patient days from 5.92 to 2.36 (P < 0.001). Despite the decrease in reportable HO-CDI cases, there were no significant differences in clinical outcomes such as hospital length of stay, intensive care unit admissions, and treatment courses. In addition, there was a significant reduction in all-cause 30-day readmissions in the post-intervention group, though CDI-related readmissions remained similar.
Conclusions:
The multi-step testing algorithm significantly reduced HO-CDI rates without compromising clinical outcomes. The study supports the use of a multi-step CDI testing algorithm to assist healthcare providers with CDI management decisions and potentially to reduce financial penalties burdened on healthcare systems.
Prior reports of healthcare-associated respiratory syncytial virus (RSV) have been limited to cases diagnosed after the third day of hospitalization. The omission of other healthcare settings where RSV transmission may occur underestimates the true incidence of healthcare-associated RSV.
Design:
Retrospective cross-sectional study.
Setting:
United States RSV Hospitalization Surveillance Network (RSV-NET) during 2016–2017 through 2018–2019 seasons.
Patients:
Laboratory-confirmed RSV-related hospitalizations in an eight-county catchment area in Tennessee.
Methods:
Surveillance data from RSV-NET were used to evaluate the population-level burden of healthcare-associated RSV. The incidence of healthcare-associated RSV was determined using the traditional definition (i.e., positive RSV test after hospital day 3) in addition to often under-recognized cases associated with recent post-acute care facility admission or a recent acute care hospitalization for a non-RSV illness in the preceding 7 days.
Results:
Among the 900 laboratory-confirmed RSV-related hospitalizations, 41 (4.6%) had traditionally defined healthcare-associated RSV. Including patients with a positive RSV test obtained in the first 3 days of hospitalization and who were either transferred to the hospital directly from a post-acute care facility or who were recently discharged from an acute care facility for a non-RSV illness in the preceding 7 days identified an additional 95 cases (10.6% of all RSV-related hospitalizations).
Conclusions:
RSV is an often under-recognized healthcare-associated infection. Capturing other healthcare exposures that may serve as the initial site of viral transmission may provide more comprehensive estimates of the burden of healthcare-associated RSV and inform improved infection prevention strategies and vaccination efforts.
It remains unclear which individuals with subthreshold depression benefit most from psychological intervention, and what long-term effects this has on symptom deterioration, response and remission.
Aims
To synthesise psychological intervention benefits in adults with subthreshold depression up to 2 years, and explore participant-level effect-modifiers.
Method
Randomised trials comparing psychological intervention with inactive control were identified via systematic search. Authors were contacted to obtain individual participant data (IPD), analysed using Bayesian one-stage meta-analysis. Treatment–covariate interactions were added to examine moderators. Hierarchical-additive models were used to explore treatment benefits conditional on baseline Patient Health Questionnaire 9 (PHQ-9) values.
Results
IPD of 10 671 individuals (50 studies) could be included. We found significant effects on depressive symptom severity up to 12 months (standardised mean-difference [s.m.d.] = −0.48 to −0.27). Effects could not be ascertained up to 24 months (s.m.d. = −0.18). Similar findings emerged for 50% symptom reduction (relative risk = 1.27–2.79), reliable improvement (relative risk = 1.38–3.17), deterioration (relative risk = 0.67–0.54) and close-to-symptom-free status (relative risk = 1.41–2.80). Among participant-level moderators, only initial depression and anxiety severity were highly credible (P > 0.99). Predicted treatment benefits decreased with lower symptom severity but remained minimally important even for very mild symptoms (s.m.d. = −0.33 for PHQ-9 = 5).
Conclusions
Psychological intervention reduces the symptom burden in individuals with subthreshold depression up to 1 year, and protects against symptom deterioration. Benefits up to 2 years are less certain. We find strong support for intervention in subthreshold depression, particularly with PHQ-9 scores ≥ 10. For very mild symptoms, scalable treatments could be an attractive option.
The Society for Healthcare Epidemiology of America, the Association of Professionals in Infection Control and Epidemiology, the Infectious Diseases Society of America, and the Pediatric Infectious Diseases Society represent the core expertise regarding healthcare infection prevention and infectious diseases and have written multisociety statement for healthcare facility leaders, regulatory agencies, payors, and patients to strengthen requirements and expectations around facility infection prevention and control (IPC) programs. Based on a systematic literature search and formal consensus process, the authors advocate raising the expectations for facility IPC programs, moving to effective programs that are:
• Foundational and influential parts of the facility’s operational structure
• Resourced with the correct expertise and leadership
• Prioritized to address all potential infectious harms
This document discusses the IPC program’s leadership—a dyad model that includes both physician and infection preventionist leaders—its reporting structure, expertise, and competencies of its members, and the roles and accountability of partnering groups within the healthcare facility. The document outlines a process for identifying minimum IPC program medical director support. It applies to all types of healthcare settings except post-acute long-term care and focuses on resources for the IPC program. Long-term acute care hospital (LTACH) staffing and antimicrobial stewardship programs will be discussed in subsequent documents.
Inadequate recruitment and retention impede clinical trial goals. Emerging decentralized clinical trials (DCTs) leveraging digital health technologies (DHTs) for remote recruitment and data collection aim to address barriers to participation in traditional trials. The ACTIV-6 trial is a DCT using DHTs, but participants’ experiences of such trials remain largely unknown. This study explored participants’ perspectives of the ACTIV-6 DCT that tested outpatient COVID-19 therapeutics.
Methods:
Participants in the ACTIV-6 study were recruited via email to share their day-to-day trial experiences during 1-hour virtual focus groups. Two human factors researchers guided group discussions through a semi-structured script that probed expectations and perceptions of study activities. Qualitative data analysis was conducted using a grounded theory approach with open coding to identify key themes.
Results:
Twenty-eight ACTIV-6 study participants aged 30+ years completed a virtual focus group including 1–4 participants each. Analysis yielded three major themes: perceptions of the DCT experience, study activity engagement, and trust. Participants perceived the use of remote DCT procedures supported by DHTs as an acceptable and efficient method of organizing and tracking study activities, communicating with study personnel, and managing study medications at home. Use of social media was effective in supporting geographically dispersed participant recruitment but also raised issues with trust and study legitimacy.
Conclusions:
While participants in this qualitative study viewed the DCT-with-DHT approach as reasonably efficient and engaging, they also identified challenges to address. Understanding facilitators and barriers to DCT participation and DHT interaction can help improve future research design.
Commercial targeted sprayer systems allow producers to reduce herbicide inputs but risks the possibility of not treating emerging weeds. Currently, targeted applications with the John Deere system have five spray sensitivity settings, and no published literature discusses the effects of these settings on detecting and spraying weeds of varying species, sizes, and positions in crops. Research was conducted in Arkansas, Illinois, Indiana, Mississippi, and North Carolina on plantings of corn, cotton, and soybean to determine how various factors might influence the ability of targeted applications to treat weeds. These data included 21 weed species aggregated to six classes with height, width, and densities ranging from 25 to 0.25 cm, 25 to 0.25 cm, and 14.3 to 0.04 plants m−2, respectively. Crop and weed density did not influence the likelihood of treating the weeds. As expected, the sensitivity setting alters the ability to treat weeds. Targeted applications (across sensitivity settings, median weed height and width, and density of 2.4 plants m−2) resulted in a treatment success of 99.6% to 84.4% for Convolvulaceae, 99.1% to 68.8% for decumbent broadleaf weeds, 98.9% to 62.9% for Malvaceae, 99.1% to 70.3% for Poaceae, 98.0% to 48.3% for Amaranthaceae, and 98.5% to 55.8% for yellow nutsedge. Reducing the sensitivity setting reduced the ability to treat weeds. The size of weeds aided targeted application success, with larger weeds being more readily treated through easier detection. Based on these findings, various conditions can affect the outcome of targeted multinozzle applications. Additionally, the analyses highlight some of the parameters to consider when using these technologies.
Introducing new herbicides requires a comprehensive understanding of how crops respond to various herbicide-related factors. Fluridone was registered for use in rice production in 2023, but research on rice tolerance to this herbicide is lacking. Hence, field research aimed to 1) evaluate the effect of fluridone application timing on rice tolerance and 2) assess rice response to fluridone in a mixture with standard rice herbicides applied to 3-leaf rice. Both experiments were conducted in a delay-flooded dry-seeded system using a randomized complete block design, with four replications. Treatments in the first experiment included a nontreated control and 10 application timings, ranging from 20 d preplant to postflood. The second experiment had a two-factor factorial structure, with factor A being the presence/absence of fluridone, and factor B being herbicide partners, including bispyribac-sodium, fenoxaprop, penoxsulam, propanil, quinclorac, quizalofop, and saflufenacil. In the first experiment, the maximum injury in 2022 was 28%, caused by the preemergence treatment. In 2023, fluridone applied preemergence caused the greatest injury (42%) 2 wk after flood establishment, declining to 37% in late season (13 d before rice reached 50% heading). Yield reductions of 21% occurred with the delayed preemergence treatment in 2022 and 42% with the preemergence treatment in 2023. Mixing fluridone with standard herbicides increased rice injury by no more than eight percentage points compared with the herbicides applied alone. Additionally, no adverse effects on rice groundcover or grain yield resulted from fluridone in the mixture. These results indicate a need to avoid fluridone applications near planting because of negative impacts on rice. Furthermore, fluridone can be mixed with commonly used rice herbicides, offering minimal risk to rice.
Having a relapse of schizophrenia or recurrent psychosis is feared by patients, can cause social and personal disruption and has been suggested to cause long-term deterioration, possibly because of a toxic biological process.
Aims
To assess whether relapse affected the social and clinical outcomes of people enrolled in a 24-month randomised controlled trial of antipsychotic medication dose reduction versus maintenance treatment.
Methods
The trial involved participants with a diagnosis of schizophrenia or recurrent, non-affective psychosis. Relapse was defined as admission to hospital or significant deterioration (assessed by a blinded end-point committee). We analysed the relationship between relapse during the trial and social functioning, quality of life, symptom scores (Positive and Negative Syndrome Scale) and rates of being in employment, education or training at 24-month follow-up. We also analysed changes in these measures during the trial among those who relapsed and those who did not. Sensitivity analyses were conducted examining the effects of ‘severe’ relapse (i.e. admission to hospital).
Results
During the course of the trial, 82 out of 253 participants relapsed. There was no evidence for a difference between those who relapsed and those who did not on changes in social functioning, quality of life, symptom scores or overall employment rates between baseline and 24-month follow-up. Those who relapsed showed no change in their social functioning or quality of life, and a slight improvement in symptoms compared to baseline. They were more likely than those who did not relapse to have had a change in their employment status (mostly moving out of employment, education or training), although numbers changing status were small. Sensitivity analyses showed the same results for those who experienced a ‘severe’ relapse.
Conclusions
Our data provide little evidence that relapse has a detrimental effect in the long term in people with schizophrenia and recurrent psychosis.
Florpyrauxifen-benzyl is a postemergence rice herbicide that has reduced rice yield in some situations, and producers are concerned that the impact could be even greater with low rice seeding densities. Therefore, research was conducted in Stoneville, MS, from 2019 to 2021, to evaluate the effect of florpyrauxifen-benzyl on rice yield when a hybrid was seeded at reduced densities. Rice cultivar FullPage RT 7521 FP was seeded at 10, 17, 24, 30, and 37 kg ha−1. At the 4-leaf to 1-tiller growth stage, florpyrauxifen-benzyl was applied at 0 or 58 g ai ha−1. Rice injury following application of florpyrauxifen-benzyl was ≤8% across all seeding rates and evaluation intervals. Application of florpyrauxifen-benzyl reduced plant heights by 14% to all seeding rates but did not result in delayed rice maturity. When florpyrauxifen-benzyl was not applied to rice that was seeded at 10 and 17 kg ha−1 seeding rates, rice matured slower than when it was seeded at 24, 30, and 37 kg ha−1. When florpyrauxifen-benzyl was applied, rough rice grain yields were reduced by at the 17 and 37 kg ha−1 seeding rates, but not at any other seeding rate. In conclusion, application of florpyrauxifen-benzyl at a 2× rate can cause a loss of yield resulting from variation in rice densities.
There is a significant mortality gap between the general population and people with psychosis. Completion rates of regular physical health assessments for cardiovascular risk in this group are suboptimal. Point-of-care testing (POCT) for diabetes and hyperlipidaemia – providing an immediate result from a finger-prick – could improve these rates.
Aims
To evaluate the impact on patient–clinician encounters and on physical health check completion rates of implementing POCT for cardiovascular risk markers in early intervention in psychosis (EIP) services in South East England.
Method
A mixed-methods, real-world evaluation study was performed, with 40 POCT machines introduced across EIP teams in all eight mental health trusts in South East England from March to May 2021. Clinician training and support was provided. Numbers of completed physical health checks, HbA1c and lipid panel blood tests completed 6 and 12 months before and 6 months after introduction of POCT were collected for individual patients. Data were compared with those from the South West region, which acted as a control. Clinician questionnaires were administered at 2 and 8 months, capturing device usability and impacts on patient interactions.
Results
Post-POCT, South East England saw significant increases in HbA1c testing (odds ratio 2.02, 95% CI 1.17–3.49), lipid testing (odds ratio 2.38, 95% CI 1.43–3.97) and total completed health checks (odds ratio 3.61, 95% CI 1.94–7.94). These increases were not seen in the South West. Questionnaires revealed improved patient engagement, clinician empowerment and patients’ preference for POCT over traditional blood tests.
Conclusions
POCT is associated with improvements in the completion and quality of physical health checks, and thus could be a tool to enhance holistic care for individuals with psychosis.
Objectives/Goals: The identification of the cascade of molecular and cellular events occurring during the progression of focal segmental glomerulosclerosis in human kidney biopsies from kidney transplant (KTx) recipients (KTR) with normal function or recurrent FSGS to determine potential targets of intervention and therapy. Methods/Study Population: In this study, we evaluate the molecular and cellular events associated with primary FSGS in both native and transplant kidneys. We collected biopsy samples from the native normal kidney (nNK, n = 3), normal functioning allografts (NKTx, n = 3), primary FSGS in the native kidney (nFSGS, n = 1), recurrent FSGS (KTxFSGS, n = 5). KTxFSGS comprises a collection of longitudinal samples with biopsy also collected at the subsequent recurrence. Blood samples were collected during biopsy collection. Biopsies were preserved in RNAlater at the time of collection. 10X genomics chromium single nuclei RNA sequencing (snRNAseq) was performed using isolated nuclei. Data was analyzed using Seurat on R. Conditionally immortalized podocytes were treated with a patient serum to determine the change in expression observed in snRNAseq data. Results/Anticipated Results: Recurrence rates of primary FSGS are high in kidney allograft recipients up to 25–50% in first, and up to 80% in second transplants, often leading to graft loss. Our findings reveal that podocyte detachment is driven by metabolic and structural dysregulation rather than cell death, increasing VEGFA expression and disrupting glomerular endothelial cell growth and permeability. Parietal epithelial cells initially compensate by dedifferentiating toward podocytes but later increase collagen deposition, contributing to glomerular sclerosis. Increased interactions of glomerular cells with B cells exacerbate extracellular matrix deposition and scarring. We also observed tubular sclerosis and disruption of the regenerative potential of proximal tubular cells, with increased interaction with T cells. Discussion/Significance of Impact: These findings offer new insights into the pathogenesis of recurrent FSGS and suggest potential therapeutic targets and establishes a foundation for future studies to further evaluate the role of metabolic dysfunction as the cause of podocyte injury and loss.
Most scholars hold a skeptical view of the war elephant of ancient India. I show that the skepticism of present-day historians derives from ancient Rome, at the end of the Republic and the beginning of the Empire, when the Romans, having defeated the elephant-deploying powers of the Hellenistic period, ended the use of war elephants in its growing empire for all time. Late Roman war elephant skepticism was taken up by Quintus Curtius Rufus, who embraced it and strengthened it rhetorically in speeches he devised and put into Alexander’s mouth, in his history of Alexander. In this way Roman skepticism about the value of the Indian war elephant was attributed to Alexander, two centuries previous to its formation among the Romans. In modern times the late Roman view that elephants have a tendency to panic and become a greater danger to their own side was turned into a settled truth about elephant physiology, but it does not accord with the evidence offered.
Polar ring galaxies (PRGs) are a unique class of galaxies characterised by a ring of gas and stars orbiting nearly orthogonal to the main body. This study delves into the evolutionary trajectory of PRGs using the exemplary trio of NGC 3718, NGC 2685, and NGC 4262. We investigate the distinct features of PRGs by analysing their ring and host components to reveal their unique characteristics through spectral energy distribution (SED) fitting. Using CIGALE, we performed SED fitting to independently analyse the ring and host spatially resolved regions, marking the first decomposed SED analysis for PRGs, which examines stellar populations using high-resolution observations from AstroSat UVIT at a resolved scale. The UV-optical surface profiles provide an initial idea that distinct patterns in the galaxies, with differences in FUV and NUV, suggest three distinct stages of ring evolution in the selected galaxies. The study of resolved-scale stellar regions reveals that the ring regions are generally younger than their host galaxies, with the age disparity progressively decreasing along the evolutionary sequence from NGC 3718 to NGC 4262. Star formation rates (SFR) also exhibit a consistent pattern, with higher SFR in the ring of NGC 3718 compared to the others, and a progressive decrease through NGC 2685 and NGC 4262. Finally, the representation of the galaxies in the HI gas fraction versus the NUV–$\text r$ plane supports the idea that they are in three different evolutionary stages of PRG evolution, with NGC 3718 in the initial stage, NGC 2685 in the intermediate stage, and NGC 4262 representing the final stage. This study concludes that PRGs undergo various evolutionary stages, as evidenced by the observed features in the ring and host components. NGC 3718, NGC 2685, and NGC 4262 represent different stages of this evolution, highlighting the dynamic nature of PRGs and emphasising the importance of studying their evolutionary processes to gain insights into galactic formation and evolution.
Post-traumatic stress disorder (PTSD) and hypertension are highly prevalent among Veterans. Cognitive dispersion, indicating within-person variability across neuropsychological measures at one time point, is associated with increased risk of dementia. We examined interactive effects of PTSD symptom severity and hypertension on cognitive dispersion among older Veterans.
Methods:
We included 128 Vietnam-era Veterans from the Department of Defense-Alzheimer’s Disease Neuroimaging Initiative (DoD-ADNI) with a history of PTSD. Regression models examined interactions between PTSD symptom severity and hypertension on cognitive dispersion (defined as the intraindividual standard deviation across eight cognitive measures) adjusting for demographics and comorbid vascular risk factors.
Results:
There was an interaction between PTSD symptom severity and hypertension on cognitive dispersion (p = .026) but not on mean cognitive performance (p = .543). Greater PTSD symptom severity was associated with higher cognitive dispersion among those with hypertension (p = .002), but not among those without hypertension (p = .531). Results remained similar after adjusting for mean cognitive performance.
Conclusions:
Findings suggest, among older Veterans with PTSD, those with both hypertension and more severe PTSD symptoms may be at greater risk for cognitive difficulties. Further, cognitive dispersion may be a useful marker of subtle cognitive difficulties. Future research should examine these associations longitudinally and in a diverse sample.