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Loss of emotional experience and expression, known as “negative symptoms”, can significantly impact people’s emotional, cognitive, and psychological functioning. However, available evidence suggests these symptoms are often missed due to overshadowing by other difficulties. Consequently, there is a dearth of evidence for effective management. The lack of prevalence data challenges treatment resource allocation within healthcare services. Thus, this audit aims to collect relevant data on negative symptoms among service users in an NHS Trust.
The aim of this project is to understand the prevalence, demographic profile and description of “negative symptoms” among a sample of AORT service users. It also investigates the allocation of resources for its management.
Methods:
This is a mixed methods study. 100 service users who were open to AORT were randomly selected between 1 September and 31 November 2023 through the clinical record interactive search service (CRIS). Data relating to the demographics of the participants, their psychological and occupational therapy contact, and prescribed medications were extracted and anonymised. Two independent coders also read through the electronic patient journey system (ePJS) to record the language used to describe “negative symptoms” and identify occupational therapy contact.
Results:
Findings revealed that only 28% of the service users reported “negative symptoms”, with most of the reports among Black/Black British–Caribbean males. Among the study sample, only half were prescribed medication, and people with “negative symptoms” were less likely to receive occupational or psychological therapies than those without. However, no significant associations with age, gender, or race/ethnicity were found.
Conclusion:
Low prevalence of therapeutic contacts among service users who report “negative symptoms” may be related to multiple factors such as complex diagnostic tools and priorities highlighted in management pathways. These factors may increase the difficulties of expressing service users’ needs, leading to a vicious feedback loop that may become complicated to manage without support.
Next steps: A better diagnostic process could uplift the “negative symptoms” management and resource allocation. This could be achieved through a co-learning workshop on topics such as the clinical presentation and impact of “negative symptoms” and co-creation of simpler assessment proformas. It is also important that “negative symptoms” are considered in risk assessments. Finally, peer support and psychological therapeutic groups can be facilitated by teams to improve the management of “negative symptoms”.
Addiction to over-the-counter (OTC) drugs is a poorly acknowledged clinical issue, especially in developed and developing nations when the regulatory supervision is less strict. Pheniramine hydrogen maleate (PHM) is an antihistamine of the first generation that is broadly used in allergic problems and can be freely bought without a prescription as Avil. Because of its sedative, anxiolytic, and euphoric effects, there is the possibility of misuse of pheniramine. Despite the description of psychological tolerance as well as withdrawal symptoms, there are very few reported cases of pheniramine dependence in the psychiatric literature. The case under consideration is a longitudinal dependence on pheniramine, which accentuates its clinical progression and withdrawal symptoms and explains the necessity of clinicians being aware of the abuse of the widely popular antihistamines.
Methods:
A 35-year-old married businessman presented with symptoms of substance withdrawal such as restlessness, irritability, vomiting, diarrhea, headache, and insomnia following cessation of chronic pheniramine use. His past history of intravenous pheniramine (Avil) use dates back to 12 years, when he was taking 4–6 vials per day and at times 10 vials. He began using it when he was prescribed injectable pheniramine and dexamethasone to treat a chronic cough and body aches. He continued to self-administer even though he underwent routine investigations because he believed that he had recovered. He had several unsuccessful attempts at discontinuation. He had two years of abstinence after inpatient detoxification and asthma treatment but relapsed due to accidental exposure to pheniramine during his hospitalization. The mental status examination presented guilt, health preoccupation, and decreased attention. The ICD-10 criteria were used to diagnose Psychoactive Substance Dependence Syndrome (pheniramine) and comorbid bronchial asthma. He was in an action stage of the change model.
Results:
Pheniramine is also associated with the abuse potential due to its sedation and anticholinergic effects, specifically because of its use as an intravenous method of administration that enhances the bioavailability and the reinforcing effects. The likelihood of dependence emerged due to repeated self-medication of PHM for respiratory symptoms. The unexpected reexposure emphasized the importance of paying attention to medication history and pharmacovigilance.
Conclusion:
Although rare, dependency on pheniramine is a severe and underestimated clinical issue related to OTC medications. This example highlights that combined multidisciplinary management, more stringent control over the sale of antihistamine products, and increased awareness of clinicians are required. Early psychiatric intervention, structured detoxification, and psychosocial support are essential in order to recover in the long term and prevent relapse.
Quantile models are widely used across the natural and social sciences to analyze heterogeneous phenomena that conventional mean-based approaches often obscure. Yet, despite their growing importance in many disciplines, their adoption in political science has remained comparatively limited, in part because the field still lacks an accessible introduction tailored to its substantive questions and empirical practices. This Element addresses that gap by showing how quantile models can expand the methodological repertoire of political science and deepen our understanding of political phenomena. Combining methodological innovation with practical guidance, this Element introduces quantile models for both continuous and discrete response variables and illustrates their use with real-world political examples. All empirical applications are accompanied by publicly available data, code, and software, making the Element a useful resource for both teaching and research. This title is also available as Open Access on Cambridge Core.
This Element provides an overview of the origins and development of forensic linguistics in the UK. It starts with a brief overview of early forensic linguistic research in the UK context, how some of the earliest work came about and the circumstances that allowed the field to develop and grow. Following this, the Element details the UK-based developments in the forensic analysis of texts, most notably through forensic authorship analysis and profiling. Section 3 outlines the research on spoken linguistic practices in legal contexts, using the order in which one might encounter these parts of the legal system (the emergency services, the police, the courts) as a structure. Section 4 looks at recent developments in the linguistic analysis of criminal and abusive behaviours in online contexts. Finally, the Element summarises the current state of forensic linguistics in the UK, pointing to key debates and potential future directions.
This study presents the first full history of Old English poetic mise-en-page, drawing its approach from the fields of literary criticism, art history, metrics, palaeography, and the history of the book. Paying special attention to lineation, this book surveys the layout of poetry from the earliest Latin writings in England, to modern editions of the twentieth and twenty-first centuries. It argues that the vernacular verse page is not, as has often been assumed, merely constrained by linguistic status. Rather, the layout of Old English poetry is shown to be the result of engaged scribal and editorial choices, and one of a set of tools used to meet readers’ needs and to express identities. Old English verse is not laid out "like prose,” but like Old English verse.
This Element launches a broadside against the visual-centric approach that has dominated philosophical and scientific discourse about the senses. Considering the variety and breadth of sensory experiences, from the deceptively familiar territories of smell and taste to the frequently overlooked experience of touch and interoceptive processes, it challenges us to rethink the philosophical bedrock of our theories of mind. It advocates a shift towards a more multi-modal and embodied approach that values biological realities and cross-cultural insights. It analyses traditional criteria for classifying sensory modalities and examines how sensory augmentation technologies provide insight for theories of perception by virtue of sensorimotor learning. The Element also highlights the disconnect between current scientific advancements and philosophical inquiry, suggesting that refocusing on the senses more broadly defined, especially on kinesthetic experiences, illuminates new paths through the thorny 'hard problem' of consciousness. This title is also available as Open Access on Cambridge Core.
This volume comparatively explores how members of “monastic” communities, broadly understood, developed practical strategies for the construction of identity across a range of religious traditions in the greater regions of premodern Europe and Asia. In particular, it seeks to understand how the production, distribution, and reception of hagiographic material (written, visual, and performative) served as a tool for the implementation of “monastic” dynamics of legitimation. This is accomplished by pursuing and developing a two-fold approach. At an empirical level, the volume expands our scholarly understanding of the cross-cultural processes that characterize religious communities’ notions of identity. At a meta-level, it furthers a re-evaluation of our taxonomy as it challenges established notions of categories such as “monk/monastic” and “hagiography.”
Innovative novels by women published in the UK in the 1950s and 1960s have returned with a vengeance in the last decade. They have reappeared in bookshops, they have been the subject of academic work, of newspaper articles and radio programmes. Feminist critical work is likely to see this return through the trope of recovery; those interested in publishing are likely to use Pierre Bourdieu's model of 'restricted production'. This Element argues that both of these temporal models are problematic. That these novelists have not been fully present in literary culture till now is the fault neither of 'forgetting' nor the time lag inherent in restricted production, but of the specific and complex structures, dynamics and assumptions of publishing. By focusing the publishing and republishing of the work of Ann Quin (1936–1973), this Element remakes the feminist critical landscape for work on novelists from the past and on publishing.
Gravity compensation, widely employed in mechanisms such as manipulators and exoskeletons, serves to minimize unnecessary energy consumption. Enhancing the performance of gravity compensation mechanisms (GCMs) is therefore of significant practical importance. One promising approach is the development of novel design methodologies. Existing GCMs utilizing cable-pulley units exhibit limitations in terms of structural compactness and efficiency. To address these issues, this paper proposes an innovative X-type gravity compensation unit featuring an adjustable cable sequencing arrangement. The application of this unit to a passive waist exoskeleton (PWE) is further introduced. Given the potential influence of pulley size and positioning on the actual spring elongation, a pulley-angle error model is established to analyze the effect of varying pulley positions. Simulations confirm the validity of the model and demonstrate that pulley size is a non-negligible factor in system performance. Finally, an experimental platform is constructed to evaluate the performance of the PWE. Experimental results indicate a notable improvement in exoskeleton performance attributable to the unique design of the X-type unit.
Intercropping cereals and legumes may enhance system productivity by simultaneously producing grain for human consumption and crop residues for livestock feed. This study evaluated the effects of maize (Zea mays) intercropped with cowpea (Vigna unguiculata) or mucuna (Mucuna pruriens) on soil moisture dynamics, grain and forage yields, and household food and feed self-sufficiency under varying rainfall conditions. The experiment was conducted on five farms in Mutoko District, Zimbabwe, during the 2021/22 and 2022/23 growing seasons using a Randomized Complete Block Design with five treatments: sole maize, sole cowpea, sole mucuna, maize–cowpea intercropping, and maize–mucuna intercropping. Soil moisture was measured biweekly to 1.8 m depth. Each season, experimental sites were classified according to seasonal rainfall as dry (<450 mm), average (450–600 mm), or wet seasons (>600 mm).Intercropping performance was influenced by rainfall. Sole mucuna utilized more soil moisture than other cropping systems. In dry and average seasons, sole maize yielded 1,812 kg ha−1 of grain, 103% more than maize intercrops, and met annual household maize requirements. In wet seasons, maize–cowpea intercropping produced higher maize grain yields (3,273 kg ha−1) than sole maize (2,372 kg ha−1), with a land equivalent ratio of 2.18. Mid-season dry spells reduced grain yields across treatments but had limited effects on stover production. During wet seasons, mucuna-based systems generated the highest forage and crude protein yields, sufficient to feed five cattle during the dry season. These findings highlight that maize–legume intercropping can enhance food and feed production during relatively wet seasons
Individual patient data meta-analyses (IPDMAs) provide powerful tools for synthesizing evidence across studies, yet methods for addressing unmeasured confounding in observational IPDMAs with survival outcomes are rarely implemented. Instrumental variable (IV) approaches offer causal inference capabilities but face practical challenges in hierarchical data structures, particularly the lack of standard diagnostics for instrument strength in nonlinear mixed-effects models. We adapt and evaluate a frequentist mixed-effects two-stage residual inclusion (2SRI) framework for survival IPDMAs, extending traditional IV methods to accommodate study-level and temporal clustering while handling time-to-event outcomes through Cox proportional hazards models. Because classical F-statistics are unavailable for logistic mixed-effects first-stage models, we propose the Wald $\chi ^2$ statistic as a practical instrument-strength diagnostic and empirically characterize its relationship to estimator performance. Through a comprehensive simulation study with 48 scenarios—varying unmeasured confounding (weak to very strong), instrument–treatment association strength (0.3–1.0), and cross-study IV allocation patterns—we evaluated 2SRI against naive mixed-effects Cox models using bias, coverage, variance, and mean squared error. The design was anchored to realistic IPDMA structure (10 studies, $N \approx 4,357$) from pooled Ebola data, with 1,000 replications per scenario. Results show that under weak confounding, naive models dominate on all metrics. With moderate-to-strong confounding and realized Wald $\chi ^2$ exceeding 150–200, mixed-effects 2SRI substantially reduces bias and achieves near-nominal coverage, though with inflated variance. We provide empirical guideposts linking realized first-stage strength to expected performance, enabling analysts to judge when 2SRI will outperform conventional approaches in hierarchical survival IPDMAs. All simulations assume a common treatment effect across studies. Performance under heterogeneous effects remains to be established.
Droplet impingement is one of the most common phenomena in nature. However, the impact dynamics of droplets on structured heterogeneous wettability surfaces remain little explored. In this work, an investigation is conducted into the droplet impact on heterogeneous wettability surfaces composed of superhydrophobic micropillars on a hydrophilic substrate, by using an improved phase-field lattice Boltzmann model. In particular, the effects of surface geometry and impact conditions on droplet bouncing and wetting behaviours are scrutinised. Four distinct impact outcomes are identified: complete bouncing, pancake bouncing, partial wetting and complete wetting. Based on the competition among capillary, inertial and viscous forces, an analytical model is proposed to predict the maximum droplet penetration depth within the pillar gaps. A transition diagram is constructed to distinguish these different impact outcomes, with regime boundaries derived from the proposed analytical model. Finally, from the perspective of energy analysis, both the evolution of the energy budget and the surface energy distribution during the droplet impact process are revealed. These findings provide guidance for the design of heterogeneous wettability surfaces, enabling predictable control over droplet bouncing and wetting behaviours.
To determine the scope and characteristics of healthcare-associated parechovirus-A infection (HA-PI).
Design:
Cross-sectional survey.
Setting:
Hospitals with neonatal units in Japan.
Participants:
Patients with parechovirus-A infection in 2023 in Japan.
Methods:
A 2-step questionnaire survey included the primary survey ascertaining the number of patients with HA-PI in 2023, followed by the secondary survey investigating the details of the patients with HA-PI.
Results:
Of the 408 hospitals, 226 (55.4%) responded. Seven sporadic patients were reported from 6 (2.7%) hospitals between May and September 2023, diagnosed as having sepsis (n = 5) or sepsis-like illness (n = 2). The median gestational age was 37.7 weeks (IQR, 36.2–38.3). They were second-born (n = 6) or third-born (n = 1), without first-born. The median days of onset of illness were 7 days (IQR, 6–15). The locations were the newborn nursery (n = 3), growth care (n = 3), or neonatal intensive care units (n = 1). No sequelae were found at least 10 months in all patients. Parechovirus-A genotype analyses demonstrated A3 (n = 6) and unknown (n = 1). The identified sources of infection were from the mother (n = 5) or unknown (n = 2). Among the 5 mothers, 2 were symptomatic. Notably, the siblings of patients in 3 asymptomatic mothers, who had no direct contact with the patients, were all symptomatic.
Conclusions:
This nationwide survey in Japan demonstrated HA-PI can occur in neonatal units, with potential risks for nosocomial outbreaks. Suspecting HA-PI and preventive measures are critical in neonatal units.
This study investigates the unsteady oscillation cycle of sheet and tip vortex cavitation over an elliptical NACA $66_2$-415 hydrofoil using high-speed imaging and time-resolved tomographic particle image velocimetry. Synchronised measurements of radiated noise are conducted. The oscillation cycle consists of three phases, involving growth and collapse of the sheet and tip vortex cavitation, followed by intermittent rebounding of the tip vortex cavity. The collapse of the sheet cavity is triggered by a side-entrant jet, leading to the formation of the cloud and secondary vortex cavitation. The interaction between the secondary and tip vortex cavities further promotes the collapse of the latter. The three-dimensional instantaneous flow organisation indicates that the evolution of cavitation affects the centre displacement, deformation and breakdown of the tip vortex. Spanwise vortices emerge and interact with the tip vortex after the growth phase, causing violent fluctuations of the tip vortex during the collapse phase. The intense interaction between these vortices enhances the perturbation growth and promotes tip vortex breakdown. Proper orthogonal decomposition analysis reveals that the dominant unstable modes near the hydrofoil tip correspond to the displacement and deformation types. In addition to the suction-side shear layer, the vortex interaction region also exhibits intense production of turbulent kinetic energy. The temporal variation of sound pressure over an oscillation cycle indicates a strong correlation with the cavity morphology.